Healthcare Provider Details

I. General information

NPI: 1962830281
Provider Name (Legal Business Name): STEPHANIE OLIVIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LENIHAN PA-C

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 07/16/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAWS CV STE 100
NEW LONDON CT
06320-4956
US

IV. Provider business mailing address

4 SHAWS CV STE 100
NEW LONDON CT
06320-4956
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-2377
  • Fax: 860-447-2935
Mailing address:
  • Phone: 860-447-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003009
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: