MEDICARE: SIGOURNEY ALANNIS REYES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	PA01737	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356039770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIGOURNEY ALANNIS REYES PA-C

Provider Business Mailing Address
First Line	:	147 CENTRE ST APT 509
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02302-2777
Country	:	US
Telephone Number	:	508-345-2159
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 LEON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5009
Country	:	US
Telephone Number	:	617-373-3323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/21/2026

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Directions to “ SIGOURNEY ALANNIS REYES PA-C” Practice Location

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