Healthcare Provider Details

I. General information

NPI: 1508776584
Provider Name (Legal Business Name): PRISCILLAH WAITHERA KIRUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EDGARTOWN ROAD
OAKBLUFFS MA
02557
US

IV. Provider business mailing address

PO BOX 4571
VINEYARD HAVEN MA
02568-0937
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: