Provider Demographics
NPI:1386927721
Name:SADECK, JASON W (MS, PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:W
Last Name:SADECK
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
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Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1 RECOVERY RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-5011
Practice Address - Country:US
Practice Address - Phone:508-273-1980
Practice Address - Fax:508-295-9467
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4878363AS0400X, 363A00000X
RI363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical