Healthcare Provider Details

I. General information

NPI: 1144663162
Provider Name (Legal Business Name): UCED PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S LAKE ST
LEESBURG FL
34748-5920
US

IV. Provider business mailing address

PO BOX 490950
LEESBURG FL
34749-0950
US

V. Phone/Fax

Practice location:
  • Phone: 973-204-4727
  • Fax:
Mailing address:
  • Phone: 973-204-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME 106875
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME 106875
License Number StateFL

VIII. Authorized Official

Name: ARTHUR E NWAUBANI
Title or Position: OWNER
Credential: MD
Phone: 973-204-4727