Healthcare Provider Details

I. General information

NPI: 1942501416
Provider Name (Legal Business Name): SHALINI LAHOTY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 03/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AMARANTH PL
MEDFORD MA
02155-4101
US

IV. Provider business mailing address

30 AMARANTH PL
MEDFORD MA
02155-4101
US

V. Phone/Fax

Practice location:
  • Phone: 617-230-4071
  • Fax:
Mailing address:
  • Phone: 617-230-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH87480
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: