Provider Demographics
NPI:1407834658
Name:DESMOND, SARAH RACHEL (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:RACHEL
Last Name:DESMOND
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:SARAH
Other - Last Name:DESMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:88 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3004
Mailing Address - Country:US
Mailing Address - Phone:857-345-9136
Mailing Address - Fax:857-345-9136
Practice Address - Street 1:632 BLUE HILL AVE
Practice Address - Street 2:HARVARD STREET NEIGHBORHOOD HEALTH CENTER
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3213
Practice Address - Country:US
Practice Address - Phone:617-825-3400
Practice Address - Fax:617-825-8899
Is Sole Proprietor?:No
Enumeration Date:2006-01-07
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204400363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0700134Medicaid
NP4626Medicare UPIN