Healthcare Provider Details

I. General information

NPI: 1336488196
Provider Name (Legal Business Name): CHIEDOZIE UWANDU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SILVERSIDE RD STE 104
WILMINGTON DE
19809-1768
US

IV. Provider business mailing address

291 CARTER DR STE A
MIDDLETOWN DE
19709-5845
US

V. Phone/Fax

Practice location:
  • Phone: 844-365-7246
  • Fax: 844-516-0080
Mailing address:
  • Phone: 844-365-7246
  • Fax: 844-516-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberE-14275
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC1-0026117
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: