Basic Information
| Provider Information | |||||||||
| NPI: | 1386873594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELISLE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | EMILY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 354 BIRNIE AVE | ||||||||
| Address2: | HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137333470 | ||||||||
| FaxNumber: | 4137335235 | ||||||||
| Practice Location | |||||||||
| Address1: | 98 SHAKER ROAD | ||||||||
| Address2: | HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC | ||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010282731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135269515 | ||||||||
| FaxNumber: | 4135269519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2009 | ||||||||
| LastUpdateDate: | 12/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA20XX | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA20XX | 01 | MA | MA BORM LICENSE | OTHER |