Healthcare Provider Details

I. General information

NPI: 1679483168
Provider Name (Legal Business Name): BRAULIO SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HYMER ST STE B
NORTH PROVIDENCE RI
02908-1316
US

IV. Provider business mailing address

280 WASHINGTON ST APT 711
PROVIDENCE RI
02903-3606
US

V. Phone/Fax

Practice location:
  • Phone: 401-663-0325
  • Fax:
Mailing address:
  • Phone: 401-457-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number202105
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: