Healthcare Provider Details

I. General information

NPI: 1699114512
Provider Name (Legal Business Name): MATTHEW S FAVAZZA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 IYANNOUGH RD
HYANNIS MA
02601-1871
US

IV. Provider business mailing address

1070 IYANNOUGH RD
HYANNIS MA
02601-1871
US

V. Phone/Fax

Practice location:
  • Phone: 888-405-6396
  • Fax: 415-252-7176
Mailing address:
  • Phone: 888-405-6396
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2276825
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: