Healthcare Provider Details

I. General information

NPI: 1538720792
Provider Name (Legal Business Name): SHENNEL MARTINA GELIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KENYON AVE STE 280
WAKEFIELD RI
02879-4253
US

IV. Provider business mailing address

PO BOX 229
WAKEFIELD RI
02880-0229
US

V. Phone/Fax

Practice location:
  • Phone: 401-284-1212
  • Fax:
Mailing address:
  • Phone: 401-788-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD20411
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: