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NPI Code Detail

MEDICARE: MRS. STEPHANIE DADARIO LAHAISE I PA

MEDICARE: MRS. STEPHANIE DADARIO LAHAISE I PA
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 AssistantPA1799MA
2363A00000XPhysician AssistantPA00327RI

General Provider Information

NPI Number : 1740210509
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE DADARIO LAHAISE I PA
Provider Business Mailing Address
First Line : 1287 N MAIN ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02904-1856
Country : US
Telephone Number : 401-272-2724
Fax Number : 401-272-2784
Provider Business Practice Location Address
First Line : 750 RESERVOIR AVE
Second Line :
City : CRANSTON
State : RI
Zip : 02910-4423
Country : US
Telephone Number : 401-943-0761
Fax Number : 401-943-5737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 04/29/2025

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Directions to “ MRS. STEPHANIE DADARIO LAHAISE I PA” Practice Location

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