Healthcare Provider Details

I. General information

NPI: 1265268189
Provider Name (Legal Business Name): RIYA SHAILESH THANKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ELDREDGE ST # 2458
NEWTON MA
02458-2017
US

IV. Provider business mailing address

64 ELDREDGE ST # 2458
NEWTON MA
02458-2017
US

V. Phone/Fax

Practice location:
  • Phone: 781-769-4143
  • Fax: 781-769-6717
Mailing address:
  • Phone: 617-969-4925
  • Fax: 781-769-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: