KEENAN SANDOUK (NPI# 1972111029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972111029 |
| Entity Type | Individual |
| Full Name | KEENAN SANDOUK |
| Credential | DMD |
| Practice Address |
830 Chalkstone Ave Providence RI 02908-4734 |
| Practice Telephone | 4012737100 |
| Mailing Telephone | 4012737100 |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2020-07-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
830 CHALKSTONE AVE |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02908-4734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174510853 | Frances Ann Bettencourt | Nurse Practitioner | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2005-09-29 |
| 1881295277 | Johnna Bussiere | Nurse's Aide | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-11-03 |
| 1770196578 | Caroline Sophie Holman | Psychologist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-31 |
| 1104437458 | Vivian Vang | Registered Nurse | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-11 |
| 1841800604 | Wilcania Baez | Social Worker | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-06 |
| 1609484757 | Stephen Soonbeom Kwon | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-07-15 |
| 1952919011 | Yumna Arif | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-07-15 |
| 1760009518 | Hassan Saada | Nurse Practitioner | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-06-28 |
| 1952927675 | Susannah Kondrath | Psychologist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-06-18 |
| 1205465168 | Brandon Michael Berube | Occupational Therapist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-04-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548771900 | Horizon Wellness | Clinic/Center | 1339 Smith St, North Providence, RI 02908 | 2017-10-12 |
| 1477098069 | Beth Perry | Nurse Practitioner | 830 Chalstone Ave., Providence, RI 02908 | 2017-01-05 |
| 1659788735 | Brandi Kimble | Podiatrist | 825 Chalkstone Avenue, Providence, RI 02908 | 2014-07-21 |
| 1912253675 | Roger Williams Medical Center | Long Term Care Hospital | 25 Chalkstone Ave, Providence, RI 02908 | 2012-07-31 |
| 1669768818 | Elisa Semedo | Physical Therapist | 285 Promenade Street, Providence, RI 02908 | 2011-06-27 |
| 1255655502 | Caregiver Homes of Rhode Island Inc. | Custodial Care Facility | 235 Promenade Street, Providence, RI 02908 | 2010-03-16 |
| 1487884987 | Professional Ambulance LLC | Ambulance | 52 River Ave, Providence, RI 02908 | 2009-07-17 |
| 1609065804 | Stephen W Davis | Family Medicine | 299 Promenade Street, Nhpri, Providence, RI 02908 | 2007-10-24 |
| 1205053899 | John R Ricci | Dentist | 1252 Smith St, Providence, RI 02908 | 2007-04-18 |
| 1871718718 | Brett C Auclaire | Nurse Practitioner | 40 Candace Street, Providence, RI 02908 | 2007-04-16 |
| Find all providers in zip 02908 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475755 | Sarah Fellows | Student in an Organized Health Care Education/Training Program | 350 Eddy Street, Uri Nursing Education Center, Providence, RI 02903 | 2020-10-20 |
| 1346856382 | Carly Danielle Masse | Student in an Organized Health Care Education/Training Program | 350 Eddy St, Providence, RI 02903-4202 | 2020-09-16 |
| 1194337220 | Shannon Adams | Student in an Organized Health Care Education/Training Program | Brown University Box G-9999, Providence, RI 02912-0001 | 2020-08-19 |
| 1023647534 | Mary Reedy | Student in an Organized Health Care Education/Training Program | 17 University Ave, Providence, RI 02906-4121 | 2020-04-06 |
| 1730747502 | Kristian Georgiev | Student in an Organized Health Care Education/Training Program | Brown University Box G-9525, Providence, RI 02912-0001 | 2019-06-05 |
| 1053975896 | Chad Simon | Student in an Organized Health Care Education/Training Program | 70 Kennedy Plz Unit 2, Providence, RI 02903-2000 | 2019-04-26 |
| 1437642709 | Adrian Cotarelo | Student in an Organized Health Care Education/Training Program | 174 Wickenden St, Apt. 3rd Floor, Providence, RI 02903 | 2018-06-12 |
| 1134616055 | Muyide Olujola Satiregun | Student in an Organized Health Care Education/Training Program | 252 Dudley St, Providence, RI 02907-1011 | 2018-04-16 |
| 1659887503 | Michele Tracy Diamond | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave Bldg 2, Providence, RI 02908-4734 | 2017-12-14 |
| 1851821268 | Jia Jennifer Ding | Student in an Organized Health Care Education/Training Program | 101 Dudley St Ste 1440, Providence, RI 02905-2401 | 2017-06-18 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02908 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.