Provider Demographics
NPI:1336942978
Name:FLYNN, DEIDRE (DAHM)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:
Credentials:DAHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 SHADY HILL DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1404
Mailing Address - Country:US
Mailing Address - Phone:401-275-3570
Mailing Address - Fax:401-275-3570
Practice Address - Street 1:14 IMPERIAL PL UNIT 203
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4638
Practice Address - Country:US
Practice Address - Phone:401-228-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDACM00117171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist