Individual
SYDNEY SUMI MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
593 EDDY ST, LIFESPAN PHYSCIAN GROUP, PROVIDENCE, RI 02903-4923
(401) 444-2128
(401) 444-8836
Mailing address
593 EDDY ST, LIFESPAN PHYSCIAN GROUP, PROVIDENCE, RI 02903-4923
(401) 444-2128
(401) 444-8836
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
Primary
14228
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110073955A
—
MA
Enumeration date
06/28/2006
Last updated
03/31/2017
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