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General NPI Number Information
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NPI Number | 1801834320
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Entity Type | Individual
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Provider Name | SANDRA MARY DEJONG M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 1493 CAMBRIDGE ST MACHT 317B
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City | CAMBRIDGE
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State | MA
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Zip | 02139-1047
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Country | US
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Telephone | 617-665-1297
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Fax |
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Provider Business Mailing Address
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Address Line | 66 TAYLOR ST
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City | NEEDHAM
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State | MA
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Zip | 02494-1830
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Country | US
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Telephone | 781-449-7664
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 154006
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License Number State | MA
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