Basic Information
| Provider Information | |||||||||
| NPI: | 1326340357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STABRAWA | ||||||||
| FirstName: | CECYLIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | BOX #306 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365162 | ||||||||
| FaxNumber: | 6176365178 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | BOX #306 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365162 | ||||||||
| FaxNumber: | 6176365178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 11/23/2010 | ||||||||
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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 | PA4031 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.