Healthcare Provider Details

I. General information

NPI: 1801712211
Provider Name (Legal Business Name): JAMIE MARIE SMALL RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

137 ALMY ST
PROVIDENCE RI
02909-1504
US

V. Phone/Fax

Practice location:
  • Phone: 414-232-1581
  • Fax:
Mailing address:
  • Phone: 414-232-1581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN01727
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: