Provider Demographics
NPI:1427889930
Name:NIEVES, ALYSSA GRACE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GRACE
Last Name:NIEVES
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:GRACE
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 HINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1274
Mailing Address - Country:US
Mailing Address - Phone:240-855-9986
Mailing Address - Fax:
Practice Address - Street 1:1 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3715
Practice Address - Country:US
Practice Address - Phone:617-661-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10272369588390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program