Keidelyn Abreu, PA
Individual provider Active NPI Physician Assistant · Lawrence, MA
NPI 1497488795 · NPPES record last updated Jan 28, 2025
Key facts
- NPI
- 1497488795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA100904 (MA)
- Practice address
- 360 Merrimack St Ste 9
Lawrence, MA 01843-1764 - Phone
- (978) 655-6663
- Fax
- (978) 984-7384
- NPI assigned
- Jul 5, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250109001676 | MA | Practitioner - Physician Assistant | 1355879008 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Interoperability endpoints
- keidelyn.abreu.1@21969.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA100904 | MA | Yes |
Addresses
Primary practice location
360 Merrimack St Ste 9
Lawrence, MA 01843-1764
Mailing address
360 Merrimack St Ste 9
Lawrence, MA 01843-1764
Phone (978) 655-6663
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MPA10001012 | Other | MA | CONTROLLED SUBSTANCE |
Other providers in Lawrence, MA
- Karolyn Glorimar Abreu Blanco
- Ambar Abreu
- Ana Abreu
- Gladys Y Abreu
- Karina Abreu
- Moh'D Rasheed Abu-Qaoud
- Aca Family Counseling Services Inc
- Kelli Accardi
- Diana Estela Acevedo
- Lizmelody Acevedo
All providers in Lawrence, MA · Physician Assistant in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.