Healthcare Provider Details

I. General information

NPI: 1164501151
Provider Name (Legal Business Name): ANDREA L VIANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 PROVIDENCE HWY
DEDHAM MA
02026-6832
US

IV. Provider business mailing address

719 PROVIDENCE HWY
DEDHAM MA
02026-6832
US

V. Phone/Fax

Practice location:
  • Phone: 781-461-6767
  • Fax:
Mailing address:
  • Phone: 781-461-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number212532
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD21214
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number216474
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: