Individual
MARYKATE DUNLEAVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPAS, PA-C
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
001873
CT
363AM0700X
Medical Physician Assistant
029700
NY
363AM0700X
Medical Physician Assistant
9116904
FL
363AM0700X
Medical Physician Assistant
Primary
PA00489
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05/14/2009
NHPRI
RI
01
—
05/29/2009
BCBS
RI
01
—
1396800520
NPI
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
01
—
979006382
RI MEDICARE
RI
05
—
MD74353
—
RI
Enumeration date
12/27/2006
Last updated
03/05/2026
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