Healthcare Provider Details

I. General information

NPI: 1912388760
Provider Name (Legal Business Name): SHAUNNA ESCOBAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLINTON ST
WOONSOCKET RI
02895
US

IV. Provider business mailing address

450 CLINTON ST
WOONSOCKET RI
02895-3207
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax: 401-235-6896
Mailing address:
  • Phone: 401-767-4100
  • Fax: 401-235-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number286921
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD16214
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66895
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: