Provider Demographics
NPI:1508107806
Name:AUGUSTE, ARY-LEX
Entity Type:Individual
Prefix:
First Name:ARY-LEX
Middle Name:
Last Name:AUGUSTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 GEORGETOWNE DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1023
Mailing Address - Country:US
Mailing Address - Phone:754-234-3963
Mailing Address - Fax:
Practice Address - Street 1:494 GEORGETOWNE DR
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1023
Practice Address - Country:US
Practice Address - Phone:754-234-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290946367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered