Healthcare Provider Details

I. General information

NPI: 1972522662
Provider Name (Legal Business Name): JUDY MENDES-ANDRADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTON AVENUE
TAUNTON MA
02780-4010
US

IV. Provider business mailing address

60 ARNOLD AVE
CRANSTON RI
02905-3814
US

V. Phone/Fax

Practice location:
  • Phone: 508-821-5779
  • Fax: 508-821-5878
Mailing address:
  • Phone: 401-461-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPP37170
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: