Provider Demographics
NPI:1497483598
Name:OLIVEIRA, RAISSA FERREIRA (PA)
Entity Type:Individual
Prefix:MRS
First Name:RAISSA
Middle Name:FERREIRA
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:464 CONGRESS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1366
Mailing Address - Country:US
Mailing Address - Phone:203-785-4404
Mailing Address - Fax:203-785-4580
Practice Address - Street 1:464 CONGRESS AVE STE 260
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1362
Practice Address - Country:US
Practice Address - Phone:203-785-4404
Practice Address - Fax:203-785-4580
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5876363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant