Healthcare Provider Details

I. General information

NPI: 1992643043
Provider Name (Legal Business Name): AMANDA BEVERLY VISCOUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLESLEY ST STE 1
WESTON MA
02493-1571
US

IV. Provider business mailing address

202 MAPLEWOOD AVE
MILFORD CT
06460-4219
US

V. Phone/Fax

Practice location:
  • Phone: 781-768-7000
  • Fax:
Mailing address:
  • Phone: 203-275-5527
  • Fax: 203-275-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number165899
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: