Provider Demographics
NPI:1609496975
Name:MACHADO, KRISTIE MARIE
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:MACHADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 AUDUBON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5330
Mailing Address - Country:US
Mailing Address - Phone:401-261-4558
Mailing Address - Fax:
Practice Address - Street 1:183 AUDUBON RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5330
Practice Address - Country:US
Practice Address - Phone:401-261-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI000285237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI462671444Medicaid