Healthcare Provider Details

I. General information

NPI: 1427578400
Provider Name (Legal Business Name): SHAUN MICHAEL FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST, FCC A
PAWTUCKET RI
02860
US

IV. Provider business mailing address

111 BREWSTER ST FCC C
PAWTUCKET RI
02860
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2304
  • Fax: 401-729-2541
Mailing address:
  • Phone: 401-729-2769
  • Fax: 401-729-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLP0414
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: