Healthcare Provider Details

I. General information

NPI: 1780104141
Provider Name (Legal Business Name): SHIWEN YUAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 PONTIAC AVE
CRANSTON RI
02920-7944
US

IV. Provider business mailing address

420 SCRABBLETOWN RD STE A
NORTH KINGSTOWN RI
02852-3638
US

V. Phone/Fax

Practice location:
  • Phone: 401-500-0424
  • Fax: 855-268-5333
Mailing address:
  • Phone: 401-268-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLP04088
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: