Healthcare Provider Details

I. General information

NPI: 1376233817
Provider Name (Legal Business Name): SHELBY DEFARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 POST RD
WARWICK RI
02886-3169
US

IV. Provider business mailing address

2 ROSEMARY ST
COVENTRY RI
02816-6043
US

V. Phone/Fax

Practice location:
  • Phone: 401-352-0007
  • Fax:
Mailing address:
  • Phone: 401-219-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN03210
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: