Healthcare Provider Details

I. General information

NPI: 1972361012
Provider Name (Legal Business Name): PAN HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 WILLARD ST STE 203
QUINCY MA
02169-1518
US

IV. Provider business mailing address

218 WILLARD ST STE 203
QUINCY MA
02169-1518
US

V. Phone/Fax

Practice location:
  • Phone: 617-592-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA SCLAFANI
Title or Position: PRACTITIONER AND OWNER
Credential: LIC. AC.
Phone: 617-592-1900