Healthcare Provider Details

I. General information

NPI: 1649563859
Provider Name (Legal Business Name): TANYA SUTCLIFFE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA BACA MD

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

PO BOX 9484
PROVIDENCE RI
02940-9484
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4000
  • Fax:
Mailing address:
  • Phone: 401-854-2500
  • Fax: 401-854-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number64498
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD15796
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP02163
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD15796
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: