Healthcare Provider Details

I. General information

NPI: 1619705308
Provider Name (Legal Business Name): TAMMIKA MASELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 PARK AVE
CRANSTON RI
02910-2136
US

IV. Provider business mailing address

749 PARK AVE
CRANSTON RI
02910-2136
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-1110
  • Fax:
Mailing address:
  • Phone: 401-781-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: