Provider Demographics
NPI:1356039770
Name:REYES, SIGOURNEY ALANNIS (PA-C)
Entity type:Individual
Prefix:
First Name:SIGOURNEY
Middle Name:ALANNIS
Last Name:REYES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SIGOURNEY
Other - Middle Name:ALANNIS
Other - Last Name:SCRUBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:147 CENTRE ST APT 509
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2777
Mailing Address - Country:US
Mailing Address - Phone:508-345-2159
Mailing Address - Fax:
Practice Address - Street 1:10 LEON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5009
Practice Address - Country:US
Practice Address - Phone:617-373-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
RIPA01737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant