Healthcare Provider Details

I. General information

NPI: 1528106796
Provider Name (Legal Business Name): CYNTHIA MARIE SLAGA OTR/L, RN, MSN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DIMOCK ST PEDIATRICS
ROXBURY MA
02119-1029
US

IV. Provider business mailing address

36 DIAMOND DR
DRACUT MA
01826-1443
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-1140
  • Fax:
Mailing address:
  • Phone: 617-312-5946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2258341
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2258341
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: