Healthcare Provider Details

I. General information

NPI: 1538706098
Provider Name (Legal Business Name): KALEY GOVONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HIGHLAND AVE STE 311
SALEM MA
01970-2733
US

IV. Provider business mailing address

150 CHESTER RD
BLANDFORD MA
01008-9521
US

V. Phone/Fax

Practice location:
  • Phone: 978-998-0010
  • Fax: 978-224-2990
Mailing address:
  • Phone: 413-977-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: