Healthcare Provider Details

I. General information

NPI: 1477466373
Provider Name (Legal Business Name): JULIET ARTEMIS BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KENYON AVE STE 100
WAKEFIELD RI
02879-4253
US

IV. Provider business mailing address

70 KENYON AVE STE 100
WAKEFIELD RI
02879-4253
US

V. Phone/Fax

Practice location:
  • Phone: 401-777-7000
  • Fax: 401-782-6810
Mailing address:
  • Phone: 401-777-7000
  • Fax: 401-782-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: