Healthcare Provider Details

I. General information

NPI: 1750873642
Provider Name (Legal Business Name): SARAH ELLIOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 09/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOPE ST
PROVIDENCE RI
02906-2001
US

IV. Provider business mailing address

55 HOPE ST
PROVIDENCE RI
02906-2001
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-1350
  • Fax:
Mailing address:
  • Phone: 401-331-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD19228
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD19228
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD19228
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: