Individual
GRACE ROSE FANIKOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
179 LONGWOOD AVE, BOSTON, MA 02115-5804
(617) 732-2850
Mailing address
8 OAK ST, WAKEFIELD, MA 01880-3935
(781) 548-0608
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/01/2022
Last updated
04/01/2022
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