Healthcare Provider Details

I. General information

NPI: 1932064342
Provider Name (Legal Business Name): GASTON ABOUBACAR SYLLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BRACKETT HILL RD
CHARLTON MA
01507-1575
US

IV. Provider business mailing address

26 BRACKETT HILL RD
CHARLTON MA
01507-1575
US

V. Phone/Fax

Practice location:
  • Phone: 401-212-9856
  • Fax:
Mailing address:
  • Phone: 401-212-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2309796
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: