Healthcare Provider Details

I. General information

NPI: 1538079496
Provider Name (Legal Business Name): MS. SAVANNAH IASIMONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 FAIRFIELD WAY
WAKEFIELD RI
02879-8287
US

IV. Provider business mailing address

31 FAIRFIELD WAY
WAKEFIELD RI
02879-8287
US

V. Phone/Fax

Practice location:
  • Phone: 401-284-1040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: