Healthcare Provider Details

I. General information

NPI: 1033051222
Provider Name (Legal Business Name): MEGHAN ELENA BELISLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 KENYON ST
PROVIDENCE RI
02903-1434
US

IV. Provider business mailing address

825 DIAMOND HILL RD APT C
WOONSOCKET RI
02895-7403
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-9391
  • Fax:
Mailing address:
  • Phone: 401-456-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: