Healthcare Provider Details

I. General information

NPI: 1699738575
Provider Name (Legal Business Name): SAHDEV R PASSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WINTHROP ST
WORCESTER MA
01604-4435
US

IV. Provider business mailing address

33 HARRINGTON DR
HOLDEN MA
01520-2520
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-3120
  • Fax:
Mailing address:
  • Phone: 508-829-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59070
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: