Provider Demographics
NPI:1881290880
Name:CENTER FOR DEVELOPMENTAL PEDIATRICS, LLC
Entity type:Organization
Organization Name:CENTER FOR DEVELOPMENTAL PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-777-9494
Mailing Address - Street 1:148 LINDEN STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3376
Mailing Address - Country:US
Mailing Address - Phone:774-777-0950
Mailing Address - Fax:
Practice Address - Street 1:148 LINDEN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3376
Practice Address - Country:US
Practice Address - Phone:774-777-0950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty