Healthcare Provider Details

I. General information

NPI: 1578485702
Provider Name (Legal Business Name): MRS. NINA PATRICIA ROBERTSON BUSCONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA PATRICIA ROBERTSON

II. Dates (important events)

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

III. Provider practice location address

255 HIGHLAND AVE
NEEDHAM MA
02494-3023
US

IV. Provider business mailing address

658 E 6TH ST APT 1
SOUTH BOSTON MA
02127-3133
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-1884
  • Fax:
Mailing address:
  • Phone: 203-505-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP100938
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: