Provider Demographics
NPI:1184336000
Name:QUEIROZ, GRACE MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARIE
Last Name:QUEIROZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MARIE
Other - Last Name:LORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 WHITNEY AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3602
Mailing Address - Country:US
Mailing Address - Phone:203-281-4463
Mailing Address - Fax:
Practice Address - Street 1:2200 WHITNEY AVE STE 360
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3602
Practice Address - Country:US
Practice Address - Phone:203-281-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant