Healthcare Provider Details

I. General information

NPI: 1154316370
Provider Name (Legal Business Name): AMY BERROL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KENYON AVE SUITE 215
WAKEFIELD RI
02879-4239
US

IV. Provider business mailing address

10 DAVOL SQ SUITE 400
PROVIDENCE RI
02903-4754
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-0084
  • Fax: 401-782-0005
Mailing address:
  • Phone: 401-421-4000
  • Fax: 401-272-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00182
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: