Provider Demographics
NPI:1790868123
Name:RAIMONDO, SHEILA CHILLI (DO)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:CHILLI
Last Name:RAIMONDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FACTORY POND CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-2921
Mailing Address - Country:US
Mailing Address - Phone:401-949-1054
Mailing Address - Fax:
Practice Address - Street 1:1 FACTORY POND CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-2921
Practice Address - Country:US
Practice Address - Phone:401-949-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI00700717Medicare PIN
RIF75163Medicare UPIN