Healthcare Provider Details

I. General information

NPI: 1609320985
Provider Name (Legal Business Name): DEENA SAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 ALLEN AVE
WARWICK RI
02889-3962
US

IV. Provider business mailing address

73 ALLEN AVE
WARWICK RI
02889-3962
US

V. Phone/Fax

Practice location:
  • Phone: 401-391-2468
  • Fax:
Mailing address:
  • Phone: 401-391-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2262882
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: