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General NPI Number Information
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NPI Number | 1790640357
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Entity Type | Organization
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Legal Business Name | KELSUBY HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 124-126 DEWEY STREET 1B
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City | WORCESTER
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State | MA
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Zip | 01610-0000
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Country | US
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Telephone | 774-345-8205
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Fax |
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Provider Business Mailing Address
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Address Line | 124-126 DEWEY STREET 1B
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City | WORCESTER
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State | MA
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Zip | 01610-0000
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Country | US
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Telephone | 774-345-8205
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSE MARIE NYAKAKO
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Credential |
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Telephone | 774-345-8205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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