Provider Demographics
NPI:1558383505
Name:PAEZ, SANDRA L (PA-C, MS)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:PAEZ
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 PETER CIR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1219
Mailing Address - Country:US
Mailing Address - Phone:973-676-1000
Mailing Address - Fax:973-395-7084
Practice Address - Street 1:385 TREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1023
Practice Address - Country:US
Practice Address - Phone:973-676-1000
Practice Address - Fax:973-395-7084
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00071700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical