Healthcare Provider Details

I. General information

NPI: 1134826746
Provider Name (Legal Business Name): GINA FALLON SATTERFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST # OP1
PROVIDENCE RI
02905-3236
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5662
  • Fax: 401-444-4557
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01607
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: