Healthcare Provider Details

I. General information

NPI: 1124041074
Provider Name (Legal Business Name): SANDRA OREMISE VILBRUN-BRUNO P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA VILBRUN PA-C

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

940 BELMONT ST
BROCKTON MA
02301-5596
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-1855
  • Fax: 774-826-2643
Mailing address:
  • Phone: 774-826-1855
  • Fax: 774-826-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1724
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: