Healthcare Provider Details

I. General information

NPI: 1871963678
Provider Name (Legal Business Name): FALASHADE F ADEWUYI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 PROSPECT ST STE 105
PAWTUCKET RI
02860-4429
US

IV. Provider business mailing address

638 MANTON AVE
PROVIDENCE RI
02909-5612
US

V. Phone/Fax

Practice location:
  • Phone: 401-405-1300
  • Fax: 401-633-6416
Mailing address:
  • Phone: 401-405-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN275164
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: