Provider Demographics
NPI:1770049074
Name:PINNA PROFESSIONALS, LLC
Entity type:Organization
Organization Name:PINNA PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:774-413-5023
Mailing Address - Street 1:33 JARVES ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2041
Mailing Address - Country:US
Mailing Address - Phone:774-413-5023
Mailing Address - Fax:774-413-9431
Practice Address - Street 1:33 JARVES ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2041
Practice Address - Country:US
Practice Address - Phone:774-413-5023
Practice Address - Fax:774-413-9431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNA PROFESSIONALS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093944AMedicaid