Provider Demographics
NPI:1932554300
Name:VIEIRA DE OLIVEIRA, PEDRO NUNO (PSYD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:NUNO
Last Name:VIEIRA DE OLIVEIRA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 FOREST RAIN
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4358
Mailing Address - Country:US
Mailing Address - Phone:516-491-2914
Mailing Address - Fax:
Practice Address - Street 1:MALCOLM GROW MEDICAL CLINICS AND SURGERY CENTER
Practice Address - Street 2:1060 W PERIMETER RD
Practice Address - City:JB ANDREWS
Practice Address - State:VA
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:240-857-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60830297103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist