Provider Demographics
NPI:1780376400
Name:STANTON, SARAH RAY (LPN, IBCLC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:RAY
Last Name:STANTON
Suffix:
Gender:F
Credentials:LPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SHANGRI LA BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02538-1115
Mailing Address - Country:US
Mailing Address - Phone:508-292-3446
Mailing Address - Fax:
Practice Address - Street 1:23 SHANGRI LA BLVD
Practice Address - Street 2:
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-1115
Practice Address - Country:US
Practice Address - Phone:508-292-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN92883164W00000X
MA174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No164W00000XNursing Service ProvidersLicensed Practical Nurse