Healthcare Provider Details

I. General information

NPI: 1710842976
Provider Name (Legal Business Name): RENATA SASSON WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BROADWAY STE 2
PROVIDENCE RI
02909-1181
US

IV. Provider business mailing address

340 BROADWAY STE 2
PROVIDENCE RI
02909-1181
US

V. Phone/Fax

Practice location:
  • Phone: 401-484-0996
  • Fax: 401-648-4600
Mailing address:
  • Phone: 401-484-0996
  • Fax: 401-648-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RENATA SASSON
Title or Position: OWNER
Credential:
Phone: 401-484-0996