Healthcare Provider Details

I. General information

NPI: 1598176232
Provider Name (Legal Business Name): ALTAYE SHEMELS GELAYE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WINDSOR ST 1ST FLOOR
CAMBRIDGE MA
02139-3647
US

IV. Provider business mailing address

119 WINDSOR ST 1ST FLOOR
CAMBRIDGE MA
02139-3647
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-3600
  • Fax:
Mailing address:
  • Phone: 617-665-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN91128
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: