Provider Demographics
NPI:1962134510
Name:NALIVAIKA, VANESSA CATHERINE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:CATHERINE
Last Name:NALIVAIKA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BEECHCROFT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2585
Mailing Address - Country:US
Mailing Address - Phone:732-829-8833
Mailing Address - Fax:
Practice Address - Street 1:195 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5568
Practice Address - Country:US
Practice Address - Phone:617-219-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MAPA9079363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical