Provider Demographics
NPI:1639430184
Name:IGEL, MANUELA ADIELA
Entity Type:Individual
Prefix:MS
First Name:MANUELA
Middle Name:ADIELA
Last Name:IGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MANUELLE
Other - Middle Name:ADIELA
Other - Last Name:IGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:371 MOODY ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5239
Mailing Address - Country:US
Mailing Address - Phone:781-608-8777
Mailing Address - Fax:
Practice Address - Street 1:371 MOODY ST STE 106
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5239
Practice Address - Country:US
Practice Address - Phone:781-896-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253514171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist