Provider Demographics
NPI:1073225058
Name:BUDEBO, MARYJEAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARYJEAN
Middle Name:
Last Name:BUDEBO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9 ISLAND AVE APT 1204
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1328
Mailing Address - Country:US
Mailing Address - Phone:305-519-0713
Mailing Address - Fax:
Practice Address - Street 1:67 UNION ST STE 102
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-979-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2023-04-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant