Healthcare Provider Details

I. General information

NPI: 1952247231
Provider Name (Legal Business Name): KUDAKWASHE FARAI KACHERE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 KENNEDY DR APT 103
MALDEN MA
02148-3306
US

IV. Provider business mailing address

244 KENNEDY DR APT 103
MALDEN MA
02148-3306
US

V. Phone/Fax

Practice location:
  • Phone: 781-513-0038
  • Fax:
Mailing address:
  • Phone: 781-513-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA1013290
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: