Provider Demographics
NPI:1972863926
Name:STASULIS, SARAH DEERY (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DEERY
Last Name:STASULIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:DEERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:92 CAMPUS DR STE D
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7229
Mailing Address - Country:US
Mailing Address - Phone:207-662-8900
Mailing Address - Fax:207-774-9388
Practice Address - Street 1:92 CAMPUS DR STE D
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7229
Practice Address - Country:US
Practice Address - Phone:207-662-8900
Practice Address - Fax:207-774-9388
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD247052086S0129X, 208600000X
MAL-251382208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery