Provider Demographics
NPI:1134659238
Name:DOLCY, PHYLLIS JAIME (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JAIME
Last Name:DOLCY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-3915
Mailing Address - Country:US
Mailing Address - Phone:401-500-4068
Mailing Address - Fax:
Practice Address - Street 1:118 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2403
Practice Address - Country:US
Practice Address - Phone:401-273-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6966363A00000X
RIPA00978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant