Healthcare Provider Details

I. General information

NPI: 1245570852
Provider Name (Legal Business Name): SSALI S BABUMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 STATE RD
NORTH DARTMOUTH MA
02747-2612
US

IV. Provider business mailing address

11 COW POND BROOK RD
GROTON MA
01450-1577
US

V. Phone/Fax

Practice location:
  • Phone: 508-979-5557
  • Fax: 508-979-5955
Mailing address:
  • Phone: 508-562-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2299909
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: