Healthcare Provider Details

I. General information

NPI: 1750678595
Provider Name (Legal Business Name): CIDALIA TAVARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 ATWELLS AVE
PROVIDENCE RI
02909-2472
US

IV. Provider business mailing address

46 WORCESTER ST
NEW BEDFORD MA
02745-1006
US

V. Phone/Fax

Practice location:
  • Phone: 401-263-6700
  • Fax:
Mailing address:
  • Phone: 508-995-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number253470
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: