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General NPI Number Information
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NPI Number | 1437519931
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Entity Type | Individual
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Provider Name | DEIDRE VAUGHN PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 525 DOYLE PARK DR STE 102
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City | SANTA ROSA
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State | CA
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Zip | 95405-4562
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Country | US
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Telephone | 707-387-3922
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Fax | 707-523-0679
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Provider Business Mailing Address
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Address Line | 41 MALL RD NEUROSURGERY DEPT
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City | BURLINGTON
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State | MA
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Zip | 01805-0001
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Country | US
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Telephone | 781-744-7580
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Fax | 781-744-5778
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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 | PA5692
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA65505
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | MA
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