Healthcare Provider Details

I. General information

NPI: 1962325803
Provider Name (Legal Business Name): EMILY FUCCI
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: EMILY DAHLSTROM

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W PARK DR
WESTBOROUGH MA
01581-3961
US

IV. Provider business mailing address

2200 W PARK DR
WESTBOROUGH MA
01581-3961
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06261587
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: