Provider Demographics
NPI:1710355623
Name:VAIDYA, SURAIYA
Entity Type:Individual
Prefix:
First Name:SURAIYA
Middle Name:
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REHANA
Other - Middle Name:
Other - Last Name:VAIDYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:422 MYSTIC AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1940
Mailing Address - Country:US
Mailing Address - Phone:857-225-7092
Mailing Address - Fax:
Practice Address - Street 1:422 MYSTIC AVE
Practice Address - Street 2:202
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1940
Practice Address - Country:US
Practice Address - Phone:857-225-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker