Basic Information
| Provider Information | |||||||||
| NPI: | 1811613615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANGO | ||||||||
| FirstName: | MISPA | ||||||||
| MiddleName: | SHURRI | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 DEERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | SHREWSBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015451530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083717441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 SHREWSBURY ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016041689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087535554 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2022 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | RN2335732 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.