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General NPI Number Information
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NPI Number | 1073279261
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Entity Type | Individual
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Provider Name | TANISHA SOUSA AMARAL RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 245 CHAPMAN ST STE 300
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City | PROVIDENCE
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State | RI
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Zip | 02905-4539
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Country | US
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Telephone | 401-444-7152
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Fax |
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Provider Business Mailing Address
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Address Line | 117 ELLENFIELD ST
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City | PROVIDENCE
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State | RI
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Zip | 02905-4541
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Country | US
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Telephone | 401-444-5640
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Fax | 401-444-5462
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LDN01134
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License Number State | RI
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