Healthcare Provider Details

I. General information

NPI: 1619439676
Provider Name (Legal Business Name): STEPHANIE MARIE HALLISEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PLAIN ST
PROVIDENCE RI
02903-4817
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7500
  • Fax: 401-453-7598
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD21510
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: