Healthcare Provider Details

I. General information

NPI: 1396862207
Provider Name (Legal Business Name): CAMERON SICILIANO ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 JUNCTION ST
DOVER MA
02030-1706
US

IV. Provider business mailing address

9 JUNCTION ST
DOVER MA
02030-1706
US

V. Phone/Fax

Practice location:
  • Phone: 508-785-8127
  • Fax:
Mailing address:
  • Phone: 508-785-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT00351
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: