Provider Demographics
NPI:1891370433
Name:GUTIERREZ, SADEY MC KAYLA
Entity Type:Individual
Prefix:
First Name:SADEY
Middle Name:MC KAYLA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 JUDITH LN APT 4
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-7245
Mailing Address - Country:US
Mailing Address - Phone:580-478-6540
Mailing Address - Fax:
Practice Address - Street 1:13 PELHAM RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5707
Practice Address - Country:US
Practice Address - Phone:781-274-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program