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General NPI Number Information
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NPI Number | 1033055827
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Entity Type | Organization
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Legal Business Name | MANA MEDICAL CENTER LLC
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Dates
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Enumeration Date | 04/25/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 591 CENTER STREET PO BOX #1776
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City | WOLFEBORO
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State | NH
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Zip | 03894-1776
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Country | US
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Telephone | 603-515-1039
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1776
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City | WOLFEBORO
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State | NH
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Zip | 03894-1776
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Country | US
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Telephone | 603-515-1039
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Fax |
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Authorized Official
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Title or Position | OWNER, SOLE PROVIDER
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Name | DR. RAQUEL MAHIDASHTI
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Credential | NP, DNP
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Telephone | 201-663-3518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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