Provider Demographics
NPI:1205376357
Name:GYAMFI, DESMOND
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:GYAMFI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PARKVIEW DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-3942
Mailing Address - Country:US
Mailing Address - Phone:410-368-2369
Mailing Address - Fax:
Practice Address - Street 1:2 REGENCY PLZ
Practice Address - Street 2:SUITE 10
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3160
Practice Address - Country:US
Practice Address - Phone:401-331-0755
Practice Address - Fax:401-331-0701
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN49347163WI0600X
RIAPRN01652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control