Healthcare Provider Details

I. General information

NPI: 1295014181
Provider Name (Legal Business Name): MAURA CUNNINGHAM-REIDY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 ROSEMARY STREET SUITE C
NEEDHAM MA
02494-3259
US

IV. Provider business mailing address

145 ROSEMARY STREET SUITE C
NEEDHAM MA
02494-3259
US

V. Phone/Fax

Practice location:
  • Phone: 781-235-7900
  • Fax: 781-237-9930
Mailing address:
  • Phone: 781-235-7900
  • Fax: 781-237-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0711479
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN2264596
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2264596
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: