Provider Demographics
NPI:1396370284
Name:PERROTTA, SARA SUSAN (HIS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:SUSAN
Last Name:PERROTTA
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:SUSAN
Other - Last Name:DACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL STE 307
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1112
Mailing Address - Country:US
Mailing Address - Phone:401-475-6116
Mailing Address - Fax:
Practice Address - Street 1:6 BLACKSTONE VALLEY PL STE 307
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1112
Practice Address - Country:US
Practice Address - Phone:401-475-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHAD00288237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist