Provider Demographics
NPI:1871994434
Name:MEDEIROS, ASHLEY LOUISE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LOUISE
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VERANDA RD APT 4
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-1227
Mailing Address - Country:US
Mailing Address - Phone:781-774-0398
Mailing Address - Fax:
Practice Address - Street 1:15 VERANDA RD APT 4
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-1227
Practice Address - Country:US
Practice Address - Phone:781-774-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-14
Last Update Date:2014-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist