Healthcare Provider Details

I. General information

NPI: 1932019064
Provider Name (Legal Business Name): AMAVIDA OPTIMAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BESTOR LN
BLOOMFIELD CT
06002-2485
US

IV. Provider business mailing address

1 BESTOR LN
BLOOMFIELD CT
06002-2485
US

V. Phone/Fax

Practice location:
  • Phone: 860-206-2122
  • Fax: 860-243-3315
Mailing address:
  • Phone: 860-206-2122
  • Fax: 860-243-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROCHELLE COLLINS
Title or Position: PROVIDER
Credential: DO
Phone: 860-206-2122