MEDICARE: ADYSON HOLLADAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		MA

General Provider Information

NPI Number	:	1144152042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADYSON HOLLADAY

Provider Business Mailing Address
First Line	:	25 DAVIS AVE UNIT 2
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02445-7609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 ALLEGHANY ST
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02120-3338
Country	:	US
Telephone Number	:	617-524-4620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ ADYSON HOLLADAY ” Practice Location

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