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General NPI Number Information
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NPI Number | 1629967518
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Entity Type | Organization
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Legal Business Name | KEDZ AESTHETIC ISLAND
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 117A WORCESTER ST
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City | WEST BOYLSTON
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State | MA
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Zip | 01583-1715
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Country | US
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Telephone | 978-209-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 117A WORCESTER ST
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City | WEST BOYLSTON
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State | MA
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Zip | 01583-1715
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Country | US
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Telephone | 978-209-2002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEDESHIA MALIN
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Credential | DNP, APRN
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Telephone | 978-209-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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