Provider Demographics
NPI:1376643668
Name:CUTHBERTSON, SERAY (NP)
Entity Type:Individual
Prefix:
First Name:SERAY
Middle Name:
Last Name:CUTHBERTSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HIGH ST APT 73
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7712
Mailing Address - Country:US
Mailing Address - Phone:617-460-0700
Mailing Address - Fax:
Practice Address - Street 1:22 HIGH ST APT 73
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7712
Practice Address - Country:US
Practice Address - Phone:617-460-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAA0706397363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0710393Medicaid
MANP5472OtherMEDICARE
MAQ73008Medicare UPIN