Provider Demographics
NPI:1417331018
Name:MOURA, GABRIELA LAMEIRAS (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:LAMEIRAS
Last Name:MOURA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1957
Mailing Address - Country:US
Mailing Address - Phone:908-721-7047
Mailing Address - Fax:
Practice Address - Street 1:353 E 17TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3821
Practice Address - Country:US
Practice Address - Phone:212-420-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant