Healthcare Provider Details

I. General information

NPI: 1982755088
Provider Name (Legal Business Name): DAVID JOSHUA MYSELS MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST STE 11B
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

146 W RIVER ST STE 11B
PROVIDENCE RI
02904-2609
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-7445
  • Fax: 401-444-7109
Mailing address:
  • Phone: 401-444-7445
  • Fax: 401-444-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD13448
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD13448
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: