Healthcare Provider Details

I. General information

NPI: 1023872637
Provider Name (Legal Business Name): HUNTER SIMARD PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH ST STE A
HYANNIS MA
02601-3825
US

IV. Provider business mailing address

12 SWEENEY LN
PLYMOUTH MA
02360-6868
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-8282
  • Fax: 508-775-8280
Mailing address:
  • Phone: 774-283-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102069
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: