Provider Demographics
NPI:1215198460
Name:ST. HILAIRE, KENDRA AMY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:AMY
Last Name:ST. HILAIRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:AMY
Other - Last Name:SACKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1093 N. MAIN ST.
Mailing Address - Street 2:STE 1A
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:781-963-0676
Mailing Address - Fax:781-963-7417
Practice Address - Street 1:1093 N. MAIN ST.
Practice Address - Street 2:STE 1A
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-963-0676
Practice Address - Fax:781-963-7417
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2562363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant