Healthcare Provider Details

I. General information

NPI: 1548190358
Provider Name (Legal Business Name): MELISSA MERCEDES RAQUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BELMONT ST
WORCESTER MA
01605-2903
US

IV. Provider business mailing address

74 E BROOKLINE ST APT 1
BOSTON MA
02118-2350
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-6206
  • Fax: 508-334-6083
Mailing address:
  • Phone: 925-389-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2343375
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: