Provider Demographics
NPI:1447280177
Name:ASSAF, SANA (MD)
Entity type:Individual
Prefix:DR
First Name:SANA
Middle Name:
Last Name:ASSAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TANBARK RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2656
Mailing Address - Country:US
Mailing Address - Phone:978-443-0495
Mailing Address - Fax:978-443-8429
Practice Address - Street 1:616 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3376
Practice Address - Country:US
Practice Address - Phone:978-443-6862
Practice Address - Fax:978-443-8429
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3170578Medicaid
MA3170578Medicaid