Healthcare Provider Details

I. General information

NPI: 1942148572
Provider Name (Legal Business Name): TESEYRA AYBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HIGHLAND AVE
SOMERVILLE MA
02143-1933
US

IV. Provider business mailing address

47 B ST APT 2044
SOUTH BOSTON MA
02127-1804
US

V. Phone/Fax

Practice location:
  • Phone: 617-623-5277
  • Fax:
Mailing address:
  • Phone: 857-258-6542
  • Fax: 617-844-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: