Provider Demographics
NPI:1699447854
Name:VINCENT, DYAN E
Entity type:Individual
Prefix:
First Name:DYAN
Middle Name:E
Last Name:VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1327
Mailing Address - Country:US
Mailing Address - Phone:508-981-7856
Mailing Address - Fax:
Practice Address - Street 1:6 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1407
Practice Address - Country:US
Practice Address - Phone:508-981-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist