Provider Demographics
NPI:1417669524
Name:MEDEIROS, ALEXIS ANN
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANN
Last Name:MEDEIROS
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 1:6122 ARBOR DR UNIT 122
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6015
Mailing Address - Country:US
Mailing Address - Phone:508-858-7809
Mailing Address - Fax:
Practice Address - Street 1:6122 ARBOR DR UNIT 122
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6015
Practice Address - Country:US
Practice Address - Phone:508-858-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant