Healthcare Provider Details

I. General information

NPI: 1881598936
Provider Name (Legal Business Name): WANDA EVETT VILLANUEVA-MAESTRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 EVERETT AVE SUITE 13 4TH FLOOR
CHELSEA MA
02150
US

IV. Provider business mailing address

90 EVERETT AVE SUITE 13 4TH FLOOR
CHELSEA MA
02150
US

V. Phone/Fax

Practice location:
  • Phone: 857-352-1529
  • Fax:
Mailing address:
  • Phone: 857-352-1529
  • 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: