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General NPI Number Information
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NPI Number | 1629278379
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Entity Type | Individual
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Provider Name | SHANDREA RODRIGUEZ FNP
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Gender | Female
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | WAYLAND MEDICAL ASSOCIATES 160 WAYLAND AVE
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City | PROVIDENCE
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State | RI
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Zip | 02906
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Country | US
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Telephone | 401-521-1221
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Fax | 401-454-4189
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Provider Business Mailing Address
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Address Line | 160 WAYLAND AVE
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City | PROVIDENCE
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State | RI
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Zip | 02906-4304
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Country | US
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Telephone | 401-521-1221
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Fax | 401-454-4189
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN42313
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN01603
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License Number State | RI
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