Healthcare Provider Details

I. General information

NPI: 1972573160
Provider Name (Legal Business Name): RAQUEL M MAHIDASHTI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 CENTER STREET
WOLFEBORO NH
03894
US

IV. Provider business mailing address

591 CENTER STREET
WOLFEBORO NH
03894
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 TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113219-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: