Healthcare Provider Details

I. General information

NPI: 1194310862
Provider Name (Legal Business Name): SARA BETH GALLANT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 09/01/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11-15 SANDERSDALE ROAD
SOUTHBRIDGE MA
01550
US

IV. Provider business mailing address

6 AMES TRL
HOLLAND MA
01521-2603
US

V. Phone/Fax

Practice location:
  • Phone: 508-344-3054
  • Fax:
Mailing address:
  • Phone: 508-344-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAWAITING
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2319249
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: