Healthcare Provider Details

I. General information

NPI: 1184805707
Provider Name (Legal Business Name): BETTY CHENG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WORCESTER ST STE 1
SPRINGFIELD MA
01151-1056
US

IV. Provider business mailing address

950 WINTER ST 4TH FLOOR
WALTHAM MA
02451-1424
US

V. Phone/Fax

Practice location:
  • Phone: 413-304-2501
  • Fax: 413-789-0290
Mailing address:
  • Phone: 781-419-8354
  • Fax: 781-419-8479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number260685
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: