Provider Demographics
NPI:1265858245
Name:HEADLEY, SARA CLAFFERTY
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:CLAFFERTY
Last Name:HEADLEY
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:KATHLEEN
Other - Last Name:CLAFFERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1839
Mailing Address - Country:US
Mailing Address - Phone:802-882-6468
Mailing Address - Fax:802-627-8013
Practice Address - Street 1:6 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1839
Practice Address - Country:US
Practice Address - Phone:802-882-6468
Practice Address - Fax:802-627-8013
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA833753163W00000X
CA95012391363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse