Provider Demographics
NPI:1972824381
Name:FEDEROWSKI, ANYA ELISE (LIC AC)
Entity Type:Individual
Prefix:MISS
First Name:ANYA
Middle Name:ELISE
Last Name:FEDEROWSKI
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 CABOT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2265
Mailing Address - Country:US
Mailing Address - Phone:530-448-6319
Mailing Address - Fax:
Practice Address - Street 1:15 OLD ROLLINSFORD RD STE 204
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2869
Practice Address - Country:US
Practice Address - Phone:603-740-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH342171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist