Individual
MRS. NINDRA DESTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
725 ALBANY STREET, SHAPIRO LOWER LEVEL, BOSTON, MA 02118-2526
(617) 638-6287
(617) 638-6284
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5317
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110112686A
—
MA
Enumeration date
03/09/2015
Last updated
10/24/2018
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