Healthcare Provider Details

I. General information

NPI: 1528937067
Provider Name (Legal Business Name): SARY SANTOS AIRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WASHBURN AVE
BROCKTON MA
02301-3517
US

IV. Provider business mailing address

17 WASHBURN AVE
BROCKTON MA
02301-3517
US

V. Phone/Fax

Practice location:
  • Phone: 774-223-2080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number168223
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: