Basic Information
| Provider Information | |||||||||
| NPI: | 1184947293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEONARAIN | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DEONARAIN | ||||||||
| OtherFirstName: | SURUJDEI | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2 DUDLEY STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013301430 | ||||||||
| FaxNumber: | 4012770795 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 BUTLER DRIVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013301430 | ||||||||
| FaxNumber: | 4012770795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2010 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.