Healthcare Provider Details

I. General information

NPI: 1912235318
Provider Name (Legal Business Name): ELISA MARIE WASILEWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISA MARIE CAPALDI PA-C

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 COLLYER ST SUITE 302
PROVIDENCE RI
02904-1869
US

IV. Provider business mailing address

PO BOX 16149
RUMFORD RI
02916-0697
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-3236
  • Fax: 401-793-5171
Mailing address:
  • Phone: 401-453-9625
  • Fax: 401-435-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00534
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: