Provider Demographics
NPI:1053611756
Name:SADAT, AMANDA (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:SADAT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BURLINGTON WOODS DR. SUITE 100 #1010
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4503
Mailing Address - Country:US
Mailing Address - Phone:978-616-7577
Mailing Address - Fax:978-616-7599
Practice Address - Street 1:2 BURLINGTON WOODS DR. SUITE 100 #1010
Practice Address - Street 2:SUITE 1A
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4503
Practice Address - Country:US
Practice Address - Phone:978-616-7577
Practice Address - Fax:978-616-7599
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2292007363L00000X
WAAP60573927363L00000X
NH07484923363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053611756Medicaid
WAG8942228, G8942229Medicare PIN