Healthcare Provider Details

I. General information

NPI: 1508257478
Provider Name (Legal Business Name): CHELSEA KRISTINE ANDINO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA CHAMPLIN PA

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SUMNER ST. 1ST FL
STOUGHTON MA
02072
US

IV. Provider business mailing address

960 MASSACHUSETTS AVENUE FL 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 508-427-2480
  • Fax: 508-427-2489
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5290
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: