Healthcare Provider Details

I. General information

NPI: 1740210509
Provider Name (Legal Business Name): STEPHANIE DADARIO LAHAISE I PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 RESERVOIR AVE
CRANSTON RI
02910-4423
US

IV. Provider business mailing address

1287 N MAIN ST
PROVIDENCE RI
02904-1856
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-0761
  • Fax: 401-943-5737
Mailing address:
  • Phone: 401-272-2724
  • Fax: 401-272-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1799
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00327
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: