Provider Demographics
NPI:1588399943
Name:RICHARDSON, SARAH SHADE (NP)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:SHADE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:593 EDDY ST APC 6
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-793-9166
Practice Address - Fax:401-444-2788
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIRN49477207T00000X
RIAPRN03205363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty