Provider Demographics
NPI:1265066302
Name:RADEV, RADOSLAVA
Entity type:Individual
Prefix:
First Name:RADOSLAVA
Middle Name:
Last Name:RADEV
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 1:30 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2320
Mailing Address - Country:US
Mailing Address - Phone:508-369-2356
Mailing Address - Fax:
Practice Address - Street 1:1379 RT 28A # PO667
Practice Address - Street 2:
Practice Address - City:CATAUMET
Practice Address - State:MA
Practice Address - Zip Code:02534-1079
Practice Address - Country:US
Practice Address - Phone:508-369-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
MA285532171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist