Healthcare Provider Details

I. General information

NPI: 1285546077
Provider Name (Legal Business Name): PEAVANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 CHARLESBANK WAY APT C
WALTHAM MA
02453-2546
US

IV. Provider business mailing address

95 CHARLESBANK WAY APT C
WALTHAM MA
02453-2546
US

V. Phone/Fax

Practice location:
  • Phone: 413-541-9207
  • Fax:
Mailing address:
  • Phone: 413-541-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: PEACE MUUSHA
Title or Position: FOUNDER AND OPERATIONS MANAGER
Credential: DR.
Phone: 413-541-9207