Provider Demographics
NPI:1528606324
Name:CONSOLO, LYNDA LEE
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:LEE
Last Name:CONSOLO
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 1:18 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5417
Mailing Address - Country:US
Mailing Address - Phone:781-307-8160
Mailing Address - Fax:
Practice Address - Street 1:18 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5417
Practice Address - Country:US
Practice Address - Phone:781-307-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7454363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant