Provider Demographics
NPI:1164396172
Name:PLATINUM WELLNESS,PLLC
Entity type:Organization
Organization Name:PLATINUM WELLNESS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANALESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAKA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-233-4400
Mailing Address - Street 1:75 N MAIN ST # 512
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4605
Mailing Address - Country:US
Mailing Address - Phone:617-233-4400
Mailing Address - Fax:617-233-4400
Practice Address - Street 1:715B WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3037
Practice Address - Country:US
Practice Address - Phone:617-233-4400
Practice Address - Fax:617-233-4400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLATINUM WELLNESS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty