Healthcare Provider Details

I. General information

NPI: 1073982575
Provider Name (Legal Business Name): SYLVIA MATEEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GARLAND ST
EVERETT MA
02149-5066
US

IV. Provider business mailing address

103 GARLAND ST
EVERETT MA
02149-5066
US

V. Phone/Fax

Practice location:
  • Phone: 617-381-7163
  • Fax:
Mailing address:
  • Phone: 617-381-7163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21822
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: