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General NPI Number Information
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NPI Number | 1750327623
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Entity Type | Individual
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Provider Name | ANDREW XAVIER DEOLIVEIRA RPA-C
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Gender | Male
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 1300 UNION TPKE SUITE 108
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1759
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Country | US
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Telephone | 516-488-2743
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Fax | 516-488-6249
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Provider Business Mailing Address
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Address Line | 257 ROSELLE ST
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City | MINEOLA
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State | NY
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Zip | 11501-2125
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Country | US
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Telephone | 516-746-7960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 010737
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License Number State | NY
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