Healthcare Provider Details

I. General information

NPI: 1982213294
Provider Name (Legal Business Name): SABITHA SASIDHARAN PILLAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3420
  • Fax: 401-444-4921
Mailing address:
  • Phone: 401-444-3420
  • Fax: 401-444-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberLP04935
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: