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Individual
AMY D DIVASTA
Active
Individual
AMY D DIVASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
224617
MA
Other
Enumeration date
05/31/2006
Last updated
08/13/2007
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