Healthcare Provider Details

I. General information

NPI: 1538800149
Provider Name (Legal Business Name): SULEIMAN MANUEL GOMES ABIOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SAYBROOK RD STE N100
MIDDLETOWN CT
06457-4741
US

IV. Provider business mailing address

520 SAYBROOK RD STE N100
MIDDLETOWN CT
06457-4741
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-3130
  • Fax: 860-358-8657
Mailing address:
  • Phone: 860-358-3130
  • Fax: 860-358-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86288
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: