Provider Demographics
NPI:1407983604
Name:AMISANO, PHILIP GUY (RN BSN CMT)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:GUY
Last Name:AMISANO
Suffix:
Gender:M
Credentials:RN BSN CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2003
Mailing Address - Country:US
Mailing Address - Phone:617-623-3278
Mailing Address - Fax:617-623-1332
Practice Address - Street 1:5 HALL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2003
Practice Address - Country:US
Practice Address - Phone:617-623-3278
Practice Address - Fax:617-623-1332
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168148163WA0400X, 163WD0400X, 163WG0000X, 163WM1400X, 163WP0807X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health