Healthcare Provider Details

I. General information

NPI: 1114846888
Provider Name (Legal Business Name): ABUNDANT LIFE INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 PANE RD UNIT 1106
NEWINGTON CT
06111-5568
US

IV. Provider business mailing address

1145 N COLONY RD STE 3
WALLINGFORD CT
06492-1796
US

V. Phone/Fax

Practice location:
  • Phone: 860-507-9883
  • Fax: 203-621-3172
Mailing address:
  • Phone: 860-507-9883
  • Fax: 203-621-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANAICA QUAO
Title or Position: OWNER/DIRECTOR
Credential: DNP, APRN
Phone: 860-507-9883