Healthcare Provider Details

I. General information

NPI: 1548375207
Provider Name (Legal Business Name): SHEYDA NAMAZIE-KUMMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE NORTH U MASS MEMORIAL MEDICAL CTR, PEDIATRIC HOSPITALIST GRP
WORCESTER MA
01655
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-7986
  • Fax: 508-334-7989
Mailing address:
  • Phone: 800-225-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number230013
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: