Individual
MICAELA BLAINE SULLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER DR, BIDDEFORD, ME 04005-9422
(207) 283-7000
Mailing address
1 MEDICAL CENTER DR, BIDDEFORD, ME 04005-9422
(207) 283-7000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2394
ME
Other
Enumeration date
06/22/2022
Last updated
01/30/2026
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