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General NPI Number Information
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NPI Number | 1831952563
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Entity Type | Individual
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Provider Name | JASON RAMOS PEREIRA
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Gender | Male
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 50 NUNNAWAUK RD
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City | NEWTOWN
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State | CT
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Zip | 06470-2319
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Country | US
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Telephone | 203-270-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 245 GLENDALE AVE UNIT D3
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City | BRIDGEPORT
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State | CT
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Zip | 06606-2743
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Country | US
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Telephone | 203-581-2944
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12280
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License Number State | CT
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