Provider Demographics
NPI:1922876325
Name:AMAYA FLORES, ELIS DAYANA (BSH)
Entity Type:Individual
Prefix:
First Name:ELIS
Middle Name:DAYANA
Last Name:AMAYA FLORES
Suffix:
Gender:F
Credentials:BSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2974 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4232
Mailing Address - Country:US
Mailing Address - Phone:401-293-5790
Mailing Address - Fax:
Practice Address - Street 1:121 GROSVENOR AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4624
Practice Address - Country:US
Practice Address - Phone:401-692-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker