Healthcare Provider Details

I. General information

NPI: 1619290046
Provider Name (Legal Business Name): SUNDAY NKEMDICHE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 04/08/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 W CRESCENT AVE
MESA AZ
85202-2053
US

IV. Provider business mailing address

1551 W CRESCENT AVE
MESA AZ
85202-2053
US

V. Phone/Fax

Practice location:
  • Phone: 954-664-8169
  • Fax:
Mailing address:
  • Phone: 954-664-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberTPPA510
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: