Healthcare Provider Details

I. General information

NPI: 1366371445
Provider Name (Legal Business Name): DIANA FAUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 KIMBALL LN STE 310
LYNNFIELD MA
01940-2680
US

IV. Provider business mailing address

6 KIMBALL LN STE 310
LYNNFIELD MA
01940-2680
US

V. Phone/Fax

Practice location:
  • Phone: 781-246-2010
  • Fax:
Mailing address:
  • Phone: 781-246-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: