NPIMap

Organization Active NPI

Kelsuby Health & Wellness, LLC

  • Primary Care Clinic/Center
  • Worcester, MA
National Provider Identifier
1790640357
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
KELSUBY HEALTH & WELLNESS, LLC
Practice address
124-126 Dewey Street
1B
Worcester, MA 01610-0000
Phone
(774) 345-8205
NPI assigned
Dec 17, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rose Marie NyakakoNPI 1467877621
Title
Owner
Phone
(774) 345-8205

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

124-126 Dewey Street
1B
Worcester, MA 01610-0000

Mailing address

124-126 Dewey Street
1B
Worcester, MA 01610-0000
Phone (774) 345-8205

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1765929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765929600000",
    "number": "1790640357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124-126 DEWEY STREET",
            "address_2": "1B",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016100000",
            "telephone_number": "774-345-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124-126 DEWEY STREET",
            "address_2": "1B",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016100000",
            "telephone_number": "774-345-8205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELSUBY HEALTH & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-17",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-15",
        "status": "A",
        "authorized_official_last_name": "NYAKAKO",
        "authorized_official_first_name": "ROSE MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "774-345-8205"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.