Healthcare Provider Details

I. General information

NPI: 1033055827
Provider Name (Legal Business Name): MANA MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 CENTER STREET PO BOX #1776
WOLFEBORO NH
03894-1776
US

IV. Provider business mailing address

PO BOX 1776
WOLFEBORO NH
03894-1776
US

V. Phone/Fax

Practice location:
  • Phone: 603-515-1039
  • Fax:
Mailing address:
  • Phone: 603-515-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAQUEL MAHIDASHTI
Title or Position: OWNER, SOLE PROVIDER
Credential: NP, DNP
Phone: 201-663-3518