Provider Demographics
NPI:1710900972
Name:SANDELL-SOMES, LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:SANDELL-SOMES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-565-7100
Mailing Address - Fax:508-565-7105
Practice Address - Street 1:21 BRISTOL DR STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1199
Practice Address - Country:US
Practice Address - Phone:505-565-7100
Practice Address - Fax:508-565-7105
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1430Medicaid