Provider Demographics
NPI:1386873594
Name:DELISLE, SARAH EMILY (PA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:EMILY
Last Name:DELISLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 BIRNIE AVE
Mailing Address - Street 2:HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1108
Mailing Address - Country:US
Mailing Address - Phone:413-733-3470
Mailing Address - Fax:413-733-5235
Practice Address - Street 1:98 SHAKER ROAD
Practice Address - Street 2:HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2731
Practice Address - Country:US
Practice Address - Phone:413-526-9515
Practice Address - Fax:413-526-9519
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA20XX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA20XXOtherMA BORM LICENSE