1518512482 NPI number — NYSSA . A. D'HEDOUVILLE OD LLC

Table of content: HEATHER DAWN RICKAWAY PA (NPI 1649282237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518512482 NPI number — NYSSA . A. D'HEDOUVILLE OD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYSSA . A. D'HEDOUVILLE OD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518512482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
681 FALMOUTH ROAD
Provider Second Line Business Mailing Address:
UPPER LEVEL SUITE 25
Provider Business Mailing Address City Name:
MASHPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02649-6310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-477-1802
Provider Business Mailing Address Fax Number:
508-539-3713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
681 FALMOUTH ROAD
Provider Second Line Business Practice Location Address:
UPPER LEVEL SUITE 25
Provider Business Practice Location Address City Name:
MASHPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02649-6310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-477-1802
Provider Business Practice Location Address Fax Number:
508-539-3713
Provider Enumeration Date:
08/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
D'HEDOUVILLE
Authorized Official First Name:
NYSSA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
508-477-1802

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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