Healthcare Provider Details

I. General information

NPI: 1003383795
Provider Name (Legal Business Name): PHINA A MAYU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 ANGELL STREET 2ND FLOOR
PROVIDENCE RI
02906
US

IV. Provider business mailing address

534 ANGELL STREET, 2ND FLOOR
PROVIDENCE RI
02906
US

V. Phone/Fax

Practice location:
  • Phone: 401-384-7971
  • Fax: 401-340-1499
Mailing address:
  • Phone: 401-384-7971
  • Fax: 401-340-1499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN01949
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN01949
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: