Provider Demographics
NPI:1952193948
Name:CLANCY, SARAH ANNE (MED, EDS)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ANNE
Last Name:CLANCY
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4420
Mailing Address - Country:US
Mailing Address - Phone:781-686-5520
Mailing Address - Fax:
Practice Address - Street 1:9 PEACEVALE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-4417
Practice Address - Country:US
Practice Address - Phone:617-635-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA531921390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program