Healthcare Provider Details

I. General information

NPI: 1699630871
Provider Name (Legal Business Name): TAJARAH RYEEM VASSELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 GOODHUE ST UNIT 313
SALEM MA
01970-2281
US

IV. Provider business mailing address

28 GOODHUE ST UNIT 313
SALEM MA
01970-2281
US

V. Phone/Fax

Practice location:
  • Phone: 781-632-9062
  • Fax:
Mailing address:
  • Phone: 781-632-9062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10019821
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: