Healthcare Provider Details

I. General information

NPI: 1629332820
Provider Name (Legal Business Name): CHIOMA N ODUKWE ENU D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHIOMA N ODUKWE DPM

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 WASHINGTON AVENUE
NORTH HAVEN CT
06473
US

IV. Provider business mailing address

83 WASHINGTON AVENUE
NORTH HAVEN CT
06473
US

V. Phone/Fax

Practice location:
  • Phone: 203-787-3800
  • Fax: 203-787-0004
Mailing address:
  • Phone: 203-787-3800
  • Fax: 203-787-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000932
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: