Healthcare Provider Details

I. General information

NPI: 1972824381
Provider Name (Legal Business Name): ANYA ELISE FEDEROWSKI LIC AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD ROLLINSFORD RD STE 204
DOVER NH
03820-2869
US

IV. Provider business mailing address

278 CABOT ST APT 1
NEWTON MA
02460-2265
US

V. Phone/Fax

Practice location:
  • Phone: 603-740-2130
  • Fax:
Mailing address:
  • Phone: 530-448-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number342
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: