Healthcare Provider Details

I. General information

NPI: 1679252498
Provider Name (Legal Business Name): SOPHIA ANN PERRY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 10/21/2026
Certification Date: 10/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 GLOUCESTER CROSSING RD
GLOUCESTER MA
01930-2283
US

IV. Provider business mailing address

165 CHARLES RIVER PLAZA
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 978-381-7700
  • Fax:
Mailing address:
  • Phone: 617-726-2217
  • Fax: 617-724-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2343382
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: