Healthcare Provider Details

I. General information

NPI: 1114100104
Provider Name (Legal Business Name): SALLEY GIBNEY PELS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALLEY ANNE GIBNEY MD

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-6195
  • Fax: 401-444-6378
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD16634
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: