Healthcare Provider Details

I. General information

NPI: 1992621098
Provider Name (Legal Business Name): NICOLE SEDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4124
US

IV. Provider business mailing address

17 FORT HILL AVENUE EXT
YORK ME
03909-6949
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102895
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: