Individual
ELENA M STUKALIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
133 BROOKLINE AVE, ADULT TELECOM, BOSTON, MA 02215-3904
(617) 421-1000
Mailing address
147 MILK ST FL 9, PROVIDER ENROLLMENT, BOSTON, MA 02109-4806
(617) 559-8374
(617) 421-3487
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
853
MA
363AM0700X
Medical Physician Assistant
Primary
853
MA
Other
Enumeration date
08/04/2008
Last updated
08/04/2008
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