Healthcare Provider Details

I. General information

NPI: 1801234620
Provider Name (Legal Business Name): TSHILANDA SINA MUKALA F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 FRIEND ST
LYNN MA
01902-3068
US

IV. Provider business mailing address

37 FRIEND ST
LYNN MA
01902-3068
US

V. Phone/Fax

Practice location:
  • Phone: 781-715-6608
  • Fax: 781-715-6699
Mailing address:
  • Phone: 781-715-6608
  • Fax: 781-715-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN253910
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: