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General NPI Number Information
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NPI Number | 1104153683
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Entity Type | Organization
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Legal Business Name | ELIA SHAMMAS MD INC.
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | ONE RANDALL SQUARE SUITE 302
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City | PROVIDENCE
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State | RI
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Zip | 02904-2773
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Country | US
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Telephone | 401-831-6682
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Fax | 401-272-5202
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Provider Business Mailing Address
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Address Line | ONE RANDALL SQUARE SUITE 302
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City | PROVIDENCE
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State | RI
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Zip | 02904-2773
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Country | US
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Telephone | 401-831-6682
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Fax | 401-272-5202
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIA SHAMMAS
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Credential | MD
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Telephone | 401-831-6682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 3992
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License Number State | RI
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