=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932554300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEDRO NUNO VIEIRA DE OLIVEIRA PSYD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2016
-----------------------------------------------------
Last Update Date | 09/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MALCOLM GROW MEDICAL CLINICS AND SURGERY CENTER 1060 W PERIMETER RD
-----------------------------------------------------
City | JB ANDREWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-857-7186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7706 FOREST RAIN
-----------------------------------------------------
City | LIVE OAK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233-4358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-491-2914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY60830297
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------