Provider Demographics
NPI:1306434154
Name:ANDERSON, SADIE BORDEN (PA)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:BORDEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:ANN
Other - Last Name:BORDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:30 CANTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3540
Mailing Address - Country:US
Mailing Address - Phone:603-622-3623
Mailing Address - Fax:
Practice Address - Street 1:30 CANTON ST STE 2
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3540
Practice Address - Country:US
Practice Address - Phone:603-622-3623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant