Healthcare Provider Details

I. General information

NPI: 1316861842
Provider Name (Legal Business Name): MUDRA AMIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 FOSTER ST
WORCESTER MA
01608-1715
US

IV. Provider business mailing address

19 FOSTER ST
WORCESTER MA
01608-1715
US

V. Phone/Fax

Practice location:
  • Phone: 508-373-5607
  • Fax: 508-890-8515
Mailing address:
  • Phone: 508-373-5607
  • Fax: 508-890-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: