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General NPI Number Information
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NPI Number | 1396815916
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Entity Type | Individual
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Provider Name | SUSAN SLEIGHTER WILFAHRT PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 35 CONGRESS ST CHARTER PROFESSIONAL SERVICES
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City | SALEM
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State | MA
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Zip | 01970-5529
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Country | US
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Telephone | 978-741-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 66 LINCOLN AVE
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City | SOUTH HAMILTON
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State | MA
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Zip | 01982-2028
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Country | US
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Telephone | 978-468-6523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 202
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License Number State | MA
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