Provider Demographics
NPI:1053445296
Name:SASSI, CRISTEN D (MEDOTRL)
Entity Type:Individual
Prefix:
First Name:CRISTEN
Middle Name:D
Last Name:SASSI
Suffix:
Gender:F
Credentials:MEDOTRL
Other - Prefix:
Other - First Name:CRISTEN
Other - Middle Name:D
Other - Last Name:CARPENTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02808-1323
Mailing Address - Country:US
Mailing Address - Phone:401-315-2454
Mailing Address - Fax:
Practice Address - Street 1:55 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-8248
Practice Address - Country:US
Practice Address - Phone:401-284-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT000959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist