Provider Demographics
NPI:1235624891
Name:MENGALLE DIONE, SHIRLEY (DO)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MENGALLE DIONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:DIONE
Other - Last Name:MENGALLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:PRC AND CREDENTIALING
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:101 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2401
Practice Address - Country:US
Practice Address - Phone:401-274-1122
Practice Address - Fax:401-459-0100
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO01160207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology