Healthcare Provider Details

I. General information

NPI: 1851853683
Provider Name (Legal Business Name): CHRISTOPHER PAUL FIDALGO MA, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 EUGENIA ST # 3
NEW BEDFORD MA
02745-5232
US

IV. Provider business mailing address

197 EUGENIA ST # 3
NEW BEDFORD MA
02745-5232
US

V. Phone/Fax

Practice location:
  • Phone: 508-742-8722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number76686
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: