=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992368997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURPLE CRAYON PEDIATRICS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2019
-----------------------------------------------------
Last Update Date | 07/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 MILL ST STE 206
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02476-4738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-867-9220
-----------------------------------------------------
Fax | 781-530-4440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 MILL ST STE 206
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02476-4738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-867-9220
-----------------------------------------------------
Fax | 781-530-4440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/ OWNER
-----------------------------------------------------
Name | DR. SARAH B. SHELDON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 781-312-8436
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------