Healthcare Provider Details

I. General information

NPI: 1639924491
Provider Name (Legal Business Name): HELENA SHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY STREET CLAVERICK 2
PROVIDENCE RI
02903
US

IV. Provider business mailing address

125 WHIPPLE ST STE 3
PROVIDENCE RI
02908-3258
US

V. Phone/Fax

Practice location:
  • Phone: 401-297-6526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2372401
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN04258
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: