Healthcare Provider Details

I. General information

NPI: 1922918622
Provider Name (Legal Business Name): SANDEE TISDALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HUDSON RD
SUDBURY MA
01776-1757
US

IV. Provider business mailing address

26 ATKINSON LN
SUDBURY MA
01776-1939
US

V. Phone/Fax

Practice location:
  • Phone: 617-610-4469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2130812
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: