Healthcare Provider Details

I. General information

NPI: 1114346988
Provider Name (Legal Business Name): SHERISE CHANTELL ROGERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

218 MANSFIELD ST APT 3
NEW HAVEN CT
06511-3539
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2500
  • Fax:
Mailing address:
  • Phone: 718-614-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME145966
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD20503
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: