Healthcare Provider Details

I. General information

NPI: 1831188374
Provider Name (Legal Business Name): SIMA PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W RIVER ST
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

44 W RIVER ST
PROVIDENCE RI
02904-2609
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-4800
  • Fax: 401-454-0410
Mailing address:
  • Phone: 401-274-4800
  • Fax: 401-454-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00238
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: