Provider Demographics
NPI:1437519931
Name:VAUGHN, DEIDRE (PA-C)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:NEUROSURGERY DEPT
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-7580
Mailing Address - Fax:781-744-5778
Practice Address - Street 1:525 DOYLE PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4562
Practice Address - Country:US
Practice Address - Phone:707-387-3922
Practice Address - Fax:707-523-0679
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5692363A00000X
CAPA65505363A00000X
MA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical