Provider Demographics
NPI:1144181181
Name:ROSARIO, MARIELYSA CARIDAD
Entity type:Individual
Prefix:
First Name:MARIELYSA
Middle Name:CARIDAD
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 NEEDHAM ST APT 2252
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1639
Mailing Address - Country:US
Mailing Address - Phone:617-678-3892
Mailing Address - Fax:
Practice Address - Street 1:89 NEEDHAM ST APT 2252
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1639
Practice Address - Country:US
Practice Address - Phone:617-678-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310513163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse