Healthcare Provider Details

I. General information

NPI: 1902311301
Provider Name (Legal Business Name): SANDRA MENARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DAN RD STE 140
CANTON MA
02021-2860
US

IV. Provider business mailing address

45 DAN RD STE 140
CANTON MA
02021-2860
US

V. Phone/Fax

Practice location:
  • Phone: 508-232-6963
  • Fax: 508-297-8258
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number255214
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: