Healthcare Provider Details

I. General information

NPI: 1982153300
Provider Name (Legal Business Name): YUDELKA BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N COMMON ST
LYNN MA
01905-2516
US

IV. Provider business mailing address

199 N COMMON ST
LYNN MA
01905-2516
US

V. Phone/Fax

Practice location:
  • Phone: 978-406-1307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number9776
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: