Healthcare Provider Details

I. General information

NPI: 1033515275
Provider Name (Legal Business Name): CHINELO OKWUOSA M.D..
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 E MAIN ST
BRANFORD CT
06405-2907
US

IV. Provider business mailing address

3 FARM GLEN BLVD
FARMINGTON CT
06032-1981
US

V. Phone/Fax

Practice location:
  • Phone: 203-481-5591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number055121
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: