Healthcare Provider Details

I. General information

NPI: 1073489498
Provider Name (Legal Business Name): STEPHANY E NORIEGA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 HAMPTON ST UNIT 2
PROVIDENCE RI
02904-1525
US

IV. Provider business mailing address

41 HAMPTON ST UNIT 2
PROVIDENCE RI
02904-1525
US

V. Phone/Fax

Practice location:
  • Phone: 508-840-1577
  • Fax:
Mailing address:
  • Phone: 508-840-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: