Individual
MARY REEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 UNIVERSITY AVE, PROVIDENCE, RI 02906-4121
(775) 250-6885
Mailing address
17 UNIVERSITY AVE, PROVIDENCE, RI 02906-4121
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA01295
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2020
Last updated
02/10/2021
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