Healthcare Provider Details

I. General information

NPI: 1134057060
Provider Name (Legal Business Name): TASHA WALLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WASHINGTON ST # 300
LYNN MA
01901-1613
US

IV. Provider business mailing address

700 WASHINGTON ST # 300
LYNN MA
01901-1613
US

V. Phone/Fax

Practice location:
  • Phone: 781-913-8742
  • Fax:
Mailing address:
  • Phone: 781-913-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: