Provider Demographics
NPI:1487291100
Name:EVOLVD HEALTH
Entity type:Organization
Organization Name:EVOLVD HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-442-6552
Mailing Address - Street 1:85 BRAINERD RD APT 108
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4529
Mailing Address - Country:US
Mailing Address - Phone:610-442-6552
Mailing Address - Fax:
Practice Address - Street 1:85 BRAINERD RD APT 108
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-4529
Practice Address - Country:US
Practice Address - Phone:610-442-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty