Healthcare Provider Details

I. General information

NPI: 1194342360
Provider Name (Legal Business Name): AUGUSTE SHIMWA NIYIBIZI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 10/16/2026
Certification Date: 10/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 QUARRY ST STE 100
FALL RIVER MA
02723-1026
US

IV. Provider business mailing address

387 QUARRY ST STE 100
FALL RIVER MA
02723-1026
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-8111
  • Fax: 508-730-2763
Mailing address:
  • Phone: 508-679-8111
  • Fax: 508-730-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number5101028352
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number011390
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1028465
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101028352
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011390
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: