Provider Demographics
NPI:1396019808
Name:BELIVEAU, PAUL (CRNA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BELIVEAU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3034
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:516-945-3034
Practice Address - Fax:516-945-3131
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE58609367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered