Provider Demographics
NPI:1104153683
Name:ELIA SHAMMAS MD INC.
Entity type:Organization
Organization Name:ELIA SHAMMAS MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-831-6682
Mailing Address - Street 1:ONE RANDALL SQUARE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2773
Mailing Address - Country:US
Mailing Address - Phone:401-831-6682
Mailing Address - Fax:401-272-5202
Practice Address - Street 1:ONE RANDALL SQUARE
Practice Address - Street 2:SUITE 302
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2773
Practice Address - Country:US
Practice Address - Phone:401-831-6682
Practice Address - Fax:401-272-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI39922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty