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General NPI Number Information
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NPI Number | 1134986664
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Entity Type | Individual
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Provider Name | MIKAYLA A. EDWARDS PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 27 BOYLSTON ST STE 320
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-1747
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Country | US
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Telephone | 617-731-3400
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Fax | 617-566-2224
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Provider Business Mailing Address
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Address Line | 27 BOYLSTON ST STE 320
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-1747
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Country | US
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Telephone | 617-731-3400
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Fax | 617-566-2224
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA100434
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA100434
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License Number State | MA
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