Healthcare Provider Details

I. General information

NPI: 1083559611
Provider Name (Legal Business Name): MRS. EDYTA MAKUSIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CONNECTICUT AVE
SPRINGFIELD MA
01104-1011
US

IV. Provider business mailing address

127 CONNECTICUT AVE
SPRINGFIELD MA
01104-1011
US

V. Phone/Fax

Practice location:
  • Phone: 413-557-9505
  • Fax:
Mailing address:
  • Phone: 413-557-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: