Healthcare Provider Details

I. General information

NPI: 1659254951
Provider Name (Legal Business Name): AMA FREMA SELLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N MAIN ST
PROVIDENCE RI
02904-5700
US

IV. Provider business mailing address

845 N MAIN ST
PROVIDENCE RI
02904-5700
US

V. Phone/Fax

Practice location:
  • Phone: 401-999-9286
  • Fax:
Mailing address:
  • Phone: 401-999-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN2344706
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: