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NPI Code Detail

MEDICARE: SHANE MCNAMARA GAZZO PA-C

MEDICARE: SHANE MCNAMARA GAZZO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA01603RI

General Provider Information

NPI Number : 1396425427
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE MCNAMARA GAZZO PA-C
Provider Business Mailing Address
First Line : 6 JOHN H CHAFEE BLVD
Second Line :
City : NEWPORT
State : RI
Zip : 02840-1034
Country : US
Telephone Number : 401-848-2160
Fax Number : 401-847-4245
Provider Business Practice Location Address
First Line : 6 JOHN H CHAFEE BLVD
Second Line :
City : NEWPORT
State : RI
Zip : 02840-1034
Country : US
Telephone Number : 401-848-2160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2023
Last Update Date : 12/18/2025

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Directions to “ SHANE MCNAMARA GAZZO PA-C” Practice Location

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