Basic Information
| Provider Information | |||||||||
| NPI: | 1003099037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACHADO | ||||||||
| FirstName: | VANIA | ||||||||
| MiddleName: | LIMA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, CCC,SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91 LEXINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024785035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177800418 | ||||||||
| FaxNumber: | 6174840574 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 MEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021433421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176293919 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2007 | ||||||||
| LastUpdateDate: | 12/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 5808 | MA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.