Provider Demographics
NPI:1124460589
Name:ZANANIRI, MICHELLE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:ZANANIRI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MILL ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4738
Mailing Address - Country:US
Mailing Address - Phone:781-646-4345
Mailing Address - Fax:781-646-5091
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:440
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:603-866-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4766363A00000X
VA0110008638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant