Healthcare Provider Details

I. General information

NPI: 1356002018
Provider Name (Legal Business Name): XYLIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 JERSEY ST
DEDHAM MA
02026-4915
US

IV. Provider business mailing address

58 JERSEY ST
DEDHAM MA
02026-4915
US

V. Phone/Fax

Practice location:
  • Phone: 617-640-3857
  • Fax:
Mailing address:
  • Phone: 617-640-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRENDA VIGUE
Title or Position: NURSE PRACTITIONER, PRESIDENT
Credential: DNP
Phone: 617-640-3857