Healthcare Provider Details

I. General information

NPI: 1639090012
Provider Name (Legal Business Name): HERVE MUDAHAKANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN ST
MILFORD MA
01757-2806
US

IV. Provider business mailing address

300 E MAIN ST
MILFORD MA
01757-2806
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-0207
  • Fax: 508-381-1134
Mailing address:
  • Phone: 508-478-0207
  • Fax: 508-634-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: