Healthcare Provider Details

I. General information

NPI: 1538979224
Provider Name (Legal Business Name): MS. GABRIELLA NICOLE FREITAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PROVIDENCE HWY STE 200
DEDHAM MA
02026-1881
US

IV. Provider business mailing address

85 UNIVERSITY AVE UNIT 1318
WESTWOOD MA
02090-2366
US

V. Phone/Fax

Practice location:
  • Phone: 781-461-4543
  • Fax:
Mailing address:
  • Phone: 401-588-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA102521
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: