Healthcare Provider Details

I. General information

NPI: 1649014317
Provider Name (Legal Business Name): EMILY CATHERINE FERULLO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 10/30/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 WAMPANOAG TRL
RIVERSIDE RI
02915-1217
US

IV. Provider business mailing address

28 EXETER ST APT 606
BOSTON MA
02116-4844
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-8586
  • Fax: 401-414-7335
Mailing address:
  • Phone: 339-227-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: