Healthcare Provider Details

I. General information

NPI: 1558706606
Provider Name (Legal Business Name): SARAH DIANA SIDHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PILGRIM RD
WELLESLEY MA
02481-2527
US

IV. Provider business mailing address

111 PILGRIM RD
WELLESLEY MA
02481-2527
US

V. Phone/Fax

Practice location:
  • Phone: 203-803-9438
  • Fax:
Mailing address:
  • Phone: 203-803-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number1020798
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME141583
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD81619
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: