Healthcare Provider Details

I. General information

NPI: 1477347029
Provider Name (Legal Business Name): SUDBURY NEUROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 NORTH RD STE 2200
SUDBURY MA
01776-1174
US

IV. Provider business mailing address

144 NORTH RD STE 2200
SUDBURY MA
01776-1174
US

V. Phone/Fax

Practice location:
  • Phone: 351-228-4928
  • Fax:
Mailing address:
  • Phone: 351-228-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEFFREY HAINSWORTH
Title or Position: PRACTICE OWNER
Credential: DO
Phone: 351-228-4928