Individual
SHADRACK MASOO-WAITA MAINGI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
819 WORCESTER ST STE 1, SPRINGFIELD, MA 01151-1056
(413) 304-2501
(413) 789-0290
Mailing address
125 STONY HILL RD, HAMPDEN, MA 01036-9717
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
07/01/2019
Last updated
07/01/2019
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