Provider Demographics
NPI:1811881907
Name:PHITHAYAPHONE, PHOUSADY C (CCHW)
Entity type:Individual
Prefix:
First Name:PHOUSADY
Middle Name:C
Last Name:PHITHAYAPHONE
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1524
Mailing Address - Country:US
Mailing Address - Phone:401-274-8811
Mailing Address - Fax:
Practice Address - Street 1:270 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1524
Practice Address - Country:US
Practice Address - Phone:401-274-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker