Healthcare Provider Details

I. General information

NPI: 1316052665
Provider Name (Legal Business Name): SASHA A FLYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAIN ST BLDG B
NORTHBOROUGH MA
01532-2132
US

IV. Provider business mailing address

300 W MAIN ST BLDG B
NORTHBOROUGH MA
01532-2132
US

V. Phone/Fax

Practice location:
  • Phone: 508-475-9816
  • Fax: 905-218-3483
Mailing address:
  • Phone: 508-475-9816
  • Fax: 905-218-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number219713
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: