Provider Demographics
NPI:1790355691
Name:MOLLEDA, ZURISHADDAI
Entity Type:Individual
Prefix:
First Name:ZURISHADDAI
Middle Name:
Last Name:MOLLEDA
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 1:23 MARSTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4444
Mailing Address - Country:US
Mailing Address - Phone:617-797-9167
Mailing Address - Fax:
Practice Address - Street 1:23 MARSTON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4444
Practice Address - Country:US
Practice Address - Phone:617-797-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician