Provider Demographics
NPI:1912944414
Name:YANNI, PENELOPE ANNE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:ANNE
Last Name:YANNI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CUMBERLAND ST
Mailing Address - Street 2:SUITE102
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3323
Mailing Address - Country:US
Mailing Address - Phone:401-356-1940
Mailing Address - Fax:401-356-1949
Practice Address - Street 1:68 CUMBERLAND ST
Practice Address - Street 2:SUITE102
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3323
Practice Address - Country:US
Practice Address - Phone:401-356-1940
Practice Address - Fax:401-356-1949
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD113192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1527371OtherUNITED HEALTH CARE
RI412021OtherBLUE CHIP
RI7056888Medicaid
RI290566OtherBLUE CROSS BLUE SHIELD
RI470074OtherTUFTS
RI470074OtherTUFTS
RI007056888Medicare PIN