Healthcare Provider Details

I. General information

NPI: 1679778963
Provider Name (Legal Business Name): SNEHA ROBERT CAMPANELLA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALNUT ST SUTIE 520
WELLESLEY MA
02481-2118
US

IV. Provider business mailing address

65 WALNUT ST SUITE 520
WELLESLEY MA
02481-2118
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-3500
  • Fax:
Mailing address:
  • Phone: 781-237-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1800
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: