Provider Demographics
NPI:1174054647
Name:SPOSATO, GIANNA
Entity type:Individual
Prefix:
First Name:GIANNA
Middle Name:
Last Name:SPOSATO
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 1:32 SCHOFIELD AVE
Mailing Address - Street 2:3R
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571-3371
Mailing Address - Country:US
Mailing Address - Phone:774-321-4733
Mailing Address - Fax:
Practice Address - Street 1:340 MAIN ST
Practice Address - Street 2:SUITE 818
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1604
Practice Address - Country:US
Practice Address - Phone:774-321-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-25
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program