Healthcare Provider Details

I. General information

NPI: 1508246992
Provider Name (Legal Business Name): SHA YAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

IV. Provider business mailing address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4200
  • Fax:
Mailing address:
  • Phone: 401-415-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number292089-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number1027187
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberDO01566
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: