Active NPI
Nicoletta Vasta Gustafson
- Speech-Language Pathologist
- Medfield, MA
National Provider Identifier
1043631609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2676
- Practice address
- 2 Icehouse Rd
Medfield, MA 02052-1555 - Phone
- (508) 242-9478
- Fax
- (508) 242-9489
- NPI assigned
- Dec 30, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2676 | MA | Primary |
Addresses
Primary practice location
2 Icehouse Rd
Medfield, MA 02052-1555
Mailing address
2 Laurel Ave
Wellesley, MA 02481-7523
Phone (781) 237-5585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2676 | MA | MD | Neurology Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Performance Rehabilitation of Western New England LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- West Springfield, MA
- NPI 1710919063
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388361600000",
"number": "1043631609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 LAUREL AVE",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024817523",
"telephone_number": "781-237-5585",
"fax_number": "781-237-5633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 ICEHOUSE RD",
"city": "MEDFIELD",
"state": "MA",
"postal_code": "020521555",
"telephone_number": "508-242-9478",
"fax_number": "508-242-9489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VASTA GUSTAFSON",
"first_name": "NICOLETTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-30",
"last_updated": "2013-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "2676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.