Healthcare Provider Details

I. General information

NPI: 1821988502
Provider Name (Legal Business Name): LISANDRA SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 VALLEY ST BLDG 6M
PROVIDENCE RI
02909-2400
US

IV. Provider business mailing address

166 VALLEY ST BLDG 6M
PROVIDENCE RI
02909-2400
US

V. Phone/Fax

Practice location:
  • Phone: 401-626-9368
  • Fax:
Mailing address:
  • Phone: 401-626-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number201994
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number5205
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: