1518564582 NPI number — LUCIANA AMBROSI SLEIGHT MS RD

Table of content: LUCIANA AMBROSI SLEIGHT MS RD (NPI 1518564582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518564582 NPI number — LUCIANA AMBROSI SLEIGHT MS RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBROSI SLEIGHT
Provider First Name:
LUCIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMBROSI
Provider Other First Name:
LUCIANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS RD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1518564582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 INVERNESS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02360-3176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-982-2338
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SANTA CRUZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RADA TILLY
Provider Business Practice Location Address State Name:
CHUBUT
Provider Business Practice Location Address Postal Code:
09001
Provider Business Practice Location Address Country Code:
AR
Provider Business Practice Location Address Telephone Number:
617-982-2339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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