Healthcare Provider Details

I. General information

NPI: 1235961780
Provider Name (Legal Business Name): DEVIN MIA SMALLWOOD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLESLEY ST STE 1
WESTON MA
02493-1571
US

IV. Provider business mailing address

7 WHITTEMORE TER
WAKEFIELD MA
01880-2219
US

V. Phone/Fax

Practice location:
  • Phone: 781-640-7556
  • Fax:
Mailing address:
  • Phone: 781-640-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN234752
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: