Healthcare Provider Details

I. General information

NPI: 1275464430
Provider Name (Legal Business Name): SVETLANA DZHADZHAROVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 SEABROOK RD
HYANNIS MA
02601-4441
US

IV. Provider business mailing address

153 SEABROOK RD
HYANNIS MA
02601-4441
US

V. Phone/Fax

Practice location:
  • Phone: 508-901-7812
  • Fax:
Mailing address:
  • Phone: 508-901-7812
  • Fax: 508-901-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18651
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: