Provider Demographics
NPI:1083665012
Name:DEJESUS-CRUZ, ANAYDA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAYDA
Middle Name:
Last Name:DEJESUS-CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANAYDA
Other - Middle Name:
Other - Last Name:DEJESUS-CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17 STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2921
Mailing Address - Country:US
Mailing Address - Phone:508-222-3200
Mailing Address - Fax:508-222-7034
Practice Address - Street 1:687 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1518
Practice Address - Country:US
Practice Address - Phone:508-222-3200
Practice Address - Fax:508-222-7034
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159774207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3203263Medicaid
MA3203263Medicaid
MAA30876Medicare Oscar/Certification