Healthcare Provider Details

I. General information

NPI: 1265778294
Provider Name (Legal Business Name): SVETLANA M MOHEYDEEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MAIN ST
GROTON MA
01450-1236
US

IV. Provider business mailing address

24 W CHARDON RD
WINCHESTER MA
01890-3828
US

V. Phone/Fax

Practice location:
  • Phone: 978-318-5761
  • Fax: 978-318-5756
Mailing address:
  • Phone: 781-454-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4496
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: