Basic Information
| Provider Information | |||||||||
| NPI: | 1912134529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRINDAVILLE | ||||||||
| FirstName: | BREA | ||||||||
| MiddleName: | SHAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 415348 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022415348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002258885 | ||||||||
| FaxNumber: | 5083341977 | ||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014447959 | ||||||||
| FaxNumber: | 4014447144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2009 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NP0225X | MD15774 | RI | Y | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 207N00000X | 265523 | MA | N | Allopathic & Osteopathic Physicians | Dermatology | 207NP0225X | 15774 | RI | N | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 208000000X | 15774 | RI | N | Allopathic & Osteopathic Physicians | Pediatrics | 207N00000X | 15774 | RI | N | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.