Provider Demographics
NPI:1548808074
Name:JOAO, RACHEL CRISTINA
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CRISTINA
Last Name:JOAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:CRISTINA
Other - Last Name:LITCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 JORDAN LN STE 2
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:860-263-0253
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:44 DALE RD STE 204
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4351
Practice Address - Country:US
Practice Address - Phone:860-674-8830
Practice Address - Fax:860-674-8984
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT5186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program