Provider Demographics
NPI:1023298296
Name:PAEZ, SARAH ELIZABETH MARY (GNP-BC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELIZABETH MARY
Last Name:PAEZ
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:PENYACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP-BC
Mailing Address - Street 1:251 ROCK ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-3837
Mailing Address - Country:US
Mailing Address - Phone:610-248-5289
Mailing Address - Fax:617-774-0606
Practice Address - Street 1:1250 HANCOCK ST FL 5
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-421-2686
Practice Address - Fax:617-774-0606
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37445363LG0600X
MA261321363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084746AMedicaid