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General NPI Number Information
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NPI Number | 1962134510
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Entity Type | Individual
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Provider Name | VANESSA CATHERINE NALIVAIKA
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Gender | Female
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 195 WORCESTER ST
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City | WELLESLEY
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State | MA
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Zip | 02481-5568
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Country | US
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Telephone | 617-219-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 26 BEECHCROFT ST APT 1
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City | BOSTON
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State | MA
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Zip | 02135-2585
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Country | US
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Telephone | 732-829-8833
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9079
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License Number State | MA
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