Healthcare Provider Details

I. General information

NPI: 1245804939
Provider Name (Legal Business Name): STACEY-ANN MILLER MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 VETERANS MEMORIAL PKWY
RIVERSIDE RI
02915-5099
US

IV. Provider business mailing address

1011 VETERANS MEMORIAL PKWY
RIVERSIDE RI
02915-5099
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-1119
  • Fax: 401-432-1506
Mailing address:
  • Phone: 401-432-1119
  • Fax: 401-432-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberV5575
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125077686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: