NPI 1205101565

Clayton Mark Sandiford, MT

Practitioner Contractor Boston, MA

Practice location

Address: 22 Banfield Ave, Boston, MA 02126
Phone: (617) 699-9240
Mailing address: 22 Banfield Ave, Boston, MA 02126-2301

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 9751 (MA)

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Registry record

NPI: 1205101565
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Mar 2012
Record last updated: 28 Aug 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.