Healthcare Provider Details

I. General information

NPI: 1255141859
Provider Name (Legal Business Name): SARAH DEPRADINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CHURCH ST STE 14
WINCHESTER MA
01890-2538
US

IV. Provider business mailing address

2 CITYVIEW LN APT 710
QUINCY MA
02169-4658
US

V. Phone/Fax

Practice location:
  • Phone: 888-693-7103
  • Fax:
Mailing address:
  • Phone: 888-693-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN2349670
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2349670
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN2349670
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: