Healthcare Provider Details

I. General information

NPI: 1558235648
Provider Name (Legal Business Name): EMMA ROSE CYR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GRANBY RD
CHICOPEE MA
01020-1568
US

IV. Provider business mailing address

58 BUFFAM RD
PELHAM MA
01002-9801
US

V. Phone/Fax

Practice location:
  • Phone: 833-243-8255
  • Fax:
Mailing address:
  • Phone: 413-695-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2363716
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: