Healthcare Provider Details

I. General information

NPI: 1700556016
Provider Name (Legal Business Name): NAISHMED LLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 MAIN ST STE 302
SOUTHBRIDGE MA
01550-2561
US

IV. Provider business mailing address

176 MAIN ST STE 302
SOUTHBRIDGE MA
01550-2561
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-5940
  • Fax:
Mailing address:
  • Phone: 508-765-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: