Provider Demographics
NPI:1053388827
Name:ALEXANDRE, SALLY F (PA-C)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:F
Last Name:ALEXANDRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:FIGUEIREDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:500 FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1278
Practice Address - Country:US
Practice Address - Phone:508-973-1230
Practice Address - Fax:508-973-1245
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2326363A00000X
RIPA00376363A00000X
MAAP2326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPA00376OtherPA LICENSE