Healthcare Provider Details

I. General information

NPI: 1699608216
Provider Name (Legal Business Name): UDUAK EKPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 CAMPBELL AVE STE F
WEST HAVEN CT
06516-3786
US

IV. Provider business mailing address

45 WOODIN ST
HAMDEN CT
06514-4403
US

V. Phone/Fax

Practice location:
  • Phone: 203-443-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17190
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: