Healthcare Provider Details

I. General information

NPI: 1487188892
Provider Name (Legal Business Name): EDINAM AKWASI CUDJOE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1711
US

IV. Provider business mailing address

37 BROTHERS RD
STORMVILLE NY
12582-5025
US

V. Phone/Fax

Practice location:
  • Phone: 203-885-0808
  • Fax:
Mailing address:
  • Phone: 347-882-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7547
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberF341341-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341341-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: