Provider Demographics
NPI:1598925364
Name:SANGCHANINTRA, SRISAKULA
Entity Type:Individual
Prefix:
First Name:SRISAKULA
Middle Name:
Last Name:SANGCHANINTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SRISAKULA
Other - Middle Name:SANGCHANINTRA
Other - Last Name:LADADOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 WOODWARD RD
Mailing Address - Street 2:FIRST FL.
Mailing Address - City:N PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4719
Mailing Address - Country:US
Mailing Address - Phone:401-709-4240
Mailing Address - Fax:
Practice Address - Street 1:200 HIGH SERVICE AVE
Practice Address - Street 2:
Practice Address - City:N PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5113
Practice Address - Country:US
Practice Address - Phone:401-456-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA36677367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered