Healthcare Provider Details

I. General information

NPI: 1114703345
Provider Name (Legal Business Name): ELENA MARIANTHE MANCHETTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 PLAINFIELD PIKE
CRANSTON RI
02921-2031
US

IV. Provider business mailing address

2220 PLAINFIELD PIKE
CRANSTON RI
02921-2031
US

V. Phone/Fax

Practice location:
  • Phone: 401-585-8500
  • Fax:
Mailing address:
  • Phone: 401-580-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01627
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: