Healthcare Provider Details

I. General information

NPI: 1427972405
Provider Name (Legal Business Name): GABRIEL LEE OLIVEIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 EAST ST
LITCHFIELD CT
06759-3601
US

IV. Provider business mailing address

PO BOX 339
LITCHFIELD CT
06759-0339
US

V. Phone/Fax

Practice location:
  • Phone: 203-518-4379
  • Fax:
Mailing address:
  • Phone: 401-678-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number240186
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: