Healthcare Provider Details

I. General information

NPI: 1548962400
Provider Name (Legal Business Name): ALEXIS K BRENYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 LINCOLN ST
WORCESTER MA
01605-3643
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-7888
  • Fax: 508-753-6536
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1026018
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: