Provider Demographics
NPI:1194415653
Name:SAGASTUME, SANDRA NOHEMI (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:NOHEMI
Last Name:SAGASTUME
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CENTRAL ST STE 212
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2463
Mailing Address - Country:US
Mailing Address - Phone:774-719-3820
Mailing Address - Fax:
Practice Address - Street 1:132 CENTRAL ST STE 212
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-2463
Practice Address - Country:US
Practice Address - Phone:774-719-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2324228363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health