Individual
SIMONE THAVASEELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 DUDLEY ST STE 185, PROVIDENCE, RI 02905-3247
(401) 444-5795
Mailing address
195 COLLYER ST STE 201, PROVIDENCE, RI 02904-1869
(401) 272-7799
(401) 272-9299
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD13391
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659463230
GROUP NPI
—
01
—
349005986
MEDICARE GROUP PTAN
RI
Enumeration date
04/24/2007
Last updated
10/14/2011
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