Healthcare Provider Details

I. General information

NPI: 1972863926
Provider Name (Legal Business Name): SARAH DEERY STASULIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH E DEERY MD

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 CAMPUS DR STE D
SCARBOROUGH ME
04074-7229
US

IV. Provider business mailing address

92 CAMPUS DR STE D
SCARBOROUGH ME
04074-7229
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-8900
  • Fax: 207-774-9388
Mailing address:
  • Phone: 207-662-8900
  • Fax: 207-774-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL-251382
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD24705
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD24705
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: