Healthcare Provider Details

I. General information

NPI: 1801922976
Provider Name (Legal Business Name): SONIA JEAN MASSE MS, PA, ATC, PES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NORTH ST
WATERVILLE ME
04901-4974
US

IV. Provider business mailing address

18 MILLBROOK LN
AUBURN ME
04210-4091
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-8140
  • Fax:
Mailing address:
  • Phone: 724-825-8074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1363
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: