Provider Demographics
NPI:1245265602
Name:FARRY, SALLY J (NP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:FARRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 ROUTE 6A
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2051
Mailing Address - Country:US
Mailing Address - Phone:508-888-9306
Mailing Address - Fax:
Practice Address - Street 1:141 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2051
Practice Address - Country:US
Practice Address - Phone:508-888-9306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119415363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0399175Medicaid
MA0399175Medicaid