Healthcare Provider Details

I. General information

NPI: 1902523657
Provider Name (Legal Business Name): JYOTHI RAMAKRISHNAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MOUNT AUBURN ST STE 205A
CAMBRIDGE MA
02138-4530
US

IV. Provider business mailing address

28 LANTHORN RD
NORTHBOROUGH MA
01532-2498
US

V. Phone/Fax

Practice location:
  • Phone: 877-893-1482
  • Fax: 858-251-0419
Mailing address:
  • Phone: 508-641-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: