Provider Demographics
NPI:1588777072
Name:D'HEDOUVILLE, NYSSA A (OD)
Entity type:Individual
Prefix:DR
First Name:NYSSA
Middle Name:A
Last Name:D'HEDOUVILLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NYSSA
Other - Middle Name:A
Other - Last Name:FERRAZZARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:681 FALMOUTH RD UPPR LEVEL
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3327
Mailing Address - Country:US
Mailing Address - Phone:508-477-1802
Mailing Address - Fax:508-539-3713
Practice Address - Street 1:681 FALMOUTH RD UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3327
Practice Address - Country:US
Practice Address - Phone:508-477-1802
Practice Address - Fax:508-539-3713
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG663152W00000X
PAOEG001729152W00000X
MA4512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist