Healthcare Provider Details

I. General information

NPI: 1306635727
Provider Name (Legal Business Name): AMAN MISHRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date: 02/19/2026
Reactivation Date: 02/24/2026

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

736 CAMBRIDGE STREET-MOB 308
BOSTON MA
02135
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-4286
  • Fax:
Mailing address:
  • Phone: 305-528-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3018772
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: