=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669841581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYLVIA NAMBASSA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2015
-----------------------------------------------------
Last Update Date | 09/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 WINN PARK #13B
-----------------------------------------------------
City | WOBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01801-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-270-1406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 WINN PARK #13 B
-----------------------------------------------------
City | WOBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01801-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-270-1406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE
-----------------------------------------------------
Name | SYLVIA NAMBASSA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 774-270-1406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | RN2289616
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------