Healthcare Provider Details

I. General information

NPI: 1588399943
Provider Name (Legal Business Name): SARAH SHADE RICHARDSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 08/24/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST APC 6
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

117 ELLENFIELD ST
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-9166
  • Fax: 401-444-2788
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN03205
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberRN49477
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: