Healthcare Provider Details

I. General information

NPI: 1225806276
Provider Name (Legal Business Name): MAYUMI SHOI PARKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 MINERAL SPRING AVE STE 107
NORTH PROVIDENCE RI
02904-4042
US

IV. Provider business mailing address

2 DARL CT
EAST GREENWICH RI
02818-1129
US

V. Phone/Fax

Practice location:
  • Phone: 401-354-4400
  • Fax:
Mailing address:
  • Phone: 781-363-0706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAPRN03887
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN03887
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: