Healthcare Provider Details

I. General information

NPI: 1407169717
Provider Name (Legal Business Name): SARA NICOLE STULAC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVENUE YAWKEY 4
BOSTON MA
02118
US

IV. Provider business mailing address

888 COMMONWEALTH AVE 3RD FLOOR
BOSTON MA
02215-1205
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4363
  • Fax:
Mailing address:
  • Phone: 617-998-8922
  • Fax: 617-432-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12857
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number248883
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: