Provider Demographics
NPI:1720607534
Name:MAYBERRY, SARAH ASHTON (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ASHTON
Last Name:MAYBERRY
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 1:77 NEW ST UNIT 120
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1382
Mailing Address - Country:US
Mailing Address - Phone:207-701-1213
Mailing Address - Fax:
Practice Address - Street 1:1210 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2109
Practice Address - Country:US
Practice Address - Phone:617-608-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8003363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical