Healthcare Provider Details

I. General information

NPI: 1043631591
Provider Name (Legal Business Name): JUDITH SHEOLIE FERNANDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2014
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 BEACON ST STE 176
NEWTON CENTER MA
02459-1822
US

IV. Provider business mailing address

831 BEACON ST STE 176
NEWTON CENTER MA
02459-1822
US

V. Phone/Fax

Practice location:
  • Phone: 857-425-9970
  • Fax: 866-323-1329
Mailing address:
  • Phone: 857-425-9970
  • Fax: 866-323-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number277124
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number277124
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMTL001444
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: