Healthcare Provider Details

I. General information

NPI: 1225806110
Provider Name (Legal Business Name): KELLY MASULA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 JAMES ST STE 253
WORCESTER MA
01603-1038
US

IV. Provider business mailing address

40 HAILE ST
WARREN RI
02885-4002
US

V. Phone/Fax

Practice location:
  • Phone: 617-454-4397
  • Fax: 774-317-4371
Mailing address:
  • Phone: 858-524-4414
  • Fax: 774-317-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN10021517
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: