Provider Demographics
NPI:1932984432
Name:MOSCHELLA, AUDREY DANIELLE
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:DANIELLE
Last Name:MOSCHELLA
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 1:325 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2150
Mailing Address - Country:US
Mailing Address - Phone:508-455-2243
Mailing Address - Fax:
Practice Address - Street 1:325 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2150
Practice Address - Country:US
Practice Address - Phone:508-455-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7079095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist