Healthcare Provider Details

I. General information

NPI: 1609707272
Provider Name (Legal Business Name): MICHELLE VICTORIA CEPEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ABBOTT ST APT 32
PROVIDENCE RI
02906-1800
US

IV. Provider business mailing address

105 ABBOTT ST APT 32
PROVIDENCE RI
02906-1800
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-5484
  • Fax: 401-649-5484
Mailing address:
  • Phone: 401-649-5484
  • Fax: 401-649-5484

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: