Provider Demographics
NPI:1356113138
Name:MEMA, ERMIONI
Entity type:Individual
Prefix:
First Name:ERMIONI
Middle Name:
Last Name:MEMA
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 1:20 ONEIL BLVD
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1854
Mailing Address - Country:US
Mailing Address - Phone:508-222-2021
Mailing Address - Fax:508-342-1907
Practice Address - Street 1:20 ONEIL BLVD
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1854
Practice Address - Country:US
Practice Address - Phone:508-222-2021
Practice Address - Fax:508-342-1907
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA100213363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program