Healthcare Provider Details

I. General information

NPI: 1629967518
Provider Name (Legal Business Name): KEDZ AESTHETIC ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117A WORCESTER ST
WEST BOYLSTON MA
01583-1715
US

IV. Provider business mailing address

117A WORCESTER ST
WEST BOYLSTON MA
01583-1715
US

V. Phone/Fax

Practice location:
  • Phone: 978-209-2002
  • Fax:
Mailing address:
  • Phone: 978-209-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEDESHIA MALIN
Title or Position: OWNER
Credential: DNP, APRN
Phone: 978-209-2002