Provider Demographics
NPI:1649212556
Name:SILVERBERG, SANDRA A (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:SILVERBERG
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 1:319 SOUTHBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2506
Mailing Address - Country:US
Mailing Address - Phone:508-832-9646
Mailing Address - Fax:508-832-7862
Practice Address - Street 1:319 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2506
Practice Address - Country:US
Practice Address - Phone:508-832-9646
Practice Address - Fax:508-832-7862
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP13517Medicare UPIN