Healthcare Provider Details

I. General information

NPI: 1386096451
Provider Name (Legal Business Name): RASHIDA TAHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE FAIN BUILDING 3RD FLOOR 164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

164 SUMMIT AVE FAIN BUILDING 3
PROVIDENCE RI
02906-2853
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberCPA00893
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: