Healthcare Provider Details

I. General information

NPI: 1548180615
Provider Name (Legal Business Name): COSTA CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 KENT ST
QUINCY MA
02169-6490
US

IV. Provider business mailing address

65 KENT ST
QUINCY MA
02169-6490
US

V. Phone/Fax

Practice location:
  • Phone: 617-302-6963
  • Fax:
Mailing address:
  • Phone: 617-302-6963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: KAYLEE COSTA
Title or Position: OWNER
Credential: IBCLC, PMH-C
Phone: 617-302-6963