Healthcare Provider Details

I. General information

NPI: 1821653379
Provider Name (Legal Business Name): SARAH WYKA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH HARRELSON

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date: 05/09/2019
Reactivation Date: 06/27/2019

III. Provider practice location address

479 WASHINGTON ST STE 2
QUINCY MA
02169-5895
US

IV. Provider business mailing address

479 WASHINGTON ST STE 2
QUINCY MA
02169-5895
US

V. Phone/Fax

Practice location:
  • Phone: 857-529-5220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2298290
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: