Healthcare Provider Details

I. General information

NPI: 1467282061
Provider Name (Legal Business Name): INFINITE REVIVAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 NEWMAN AVE UNIT 3
SEEKONK MA
02771-4424
US

IV. Provider business mailing address

1087 NEWMAN AVE UNIT 3
SEEKONK MA
02771-4424
US

V. Phone/Fax

Practice location:
  • Phone: 508-557-1432
  • Fax:
Mailing address:
  • Phone: 508-557-1432
  • Fax: 508-318-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA FAGUNDES
Title or Position: NP
Credential:
Phone: 774-451-2713