Healthcare Provider Details

I. General information

NPI: 1316541162
Provider Name (Legal Business Name): SHAYLAH RAE SPELLMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAYLAH RAE MORSE APRN

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LAMBERT LIND HWY
WARWICK RI
02886-1131
US

IV. Provider business mailing address

75 LAMBERT LIND HWY
WARWICK RI
02886-1131
US

V. Phone/Fax

Practice location:
  • Phone: 401-681-4274
  • Fax: 401-615-2805
Mailing address:
  • Phone: 401-681-4274
  • Fax: 401-615-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCAPRN02507
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN02507
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: