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General NPI Number Information
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NPI Number | 1174193387
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Entity Type | Individual
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Provider Name | CALLY RODRIGUES PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 41 SANDERSON RD
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City | SMITHFIELD
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State | RI
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Zip | 02917-2602
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Country | US
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Telephone | 401-349-0366
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Fax |
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Provider Business Mailing Address
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Address Line | 30 JAIME LYNN LN
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City | SWANSEA
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State | MA
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Zip | 02777-4029
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Country | US
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Telephone | 508-642-1227
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01344
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License Number State | RI
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