Provider Demographics
NPI:1073230140
Name:FREMAULT MACEDO, SHEENA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:ANN
Last Name:FREMAULT MACEDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:ANN
Other - Last Name:FREMAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:24 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1810
Mailing Address - Country:US
Mailing Address - Phone:781-354-4826
Mailing Address - Fax:
Practice Address - Street 1:40 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2705
Practice Address - Country:US
Practice Address - Phone:617-629-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2279429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner