Healthcare Provider Details

I. General information

NPI: 1396690202
Provider Name (Legal Business Name): MAILE SIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 WASHINGTON ST
JAMAICA PLAIN MA
02130-2691
US

IV. Provider business mailing address

157 MURDOCK ST
BRIGHTON MA
02135-2309
US

V. Phone/Fax

Practice location:
  • Phone: 617-522-0650
  • Fax:
Mailing address:
  • Phone: 650-759-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: