Provider Demographics
NPI:1750305199
Name:STURDY MEMORIAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:STURDY MEMORIAL ASSOCIATES, INC.
Other - Org Name:PLEASANT STREET PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHYAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-236-8000
Mailing Address - Street 1:159 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2442
Mailing Address - Country:US
Mailing Address - Phone:508-236-0115
Mailing Address - Fax:508-431-1515
Practice Address - Street 1:159 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2442
Practice Address - Country:US
Practice Address - Phone:508-236-0115
Practice Address - Fax:508-431-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA697181OtherTUFTS
MA9777083Medicaid
MAM18287OtherMABC
MA9777083Medicaid
MA697181OtherTUFTS