Individual
SHAKUNTALA PRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 BREWSTER ST, MEMORIAL HOSPITAL OF RI / DEPT.OF PHYSICAL MED/REHAB, PAWTUCKET, RI 02860-4400
(401) 729-2326
(401) 729-3886
Mailing address
111 BREWSTER ST, MEMORIAL HOSPITAL OF RI / DEPT.OF PHYSICAL MED/REHAB, PAWTUCKET, RI 02860-4400
(401) 729-2326
(401) 729-3886
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD06405
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007057385
MEDICARE PTAN
RI
05
—
110087842A
—
MA
05
—
7002088
—
RI
Enumeration date
03/01/2006
Last updated
09/02/2011
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