Healthcare Provider Details

I. General information

NPI: 1992180483
Provider Name (Legal Business Name): GINEEN AFEISHA THERESA CUDJOE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2015
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W PINE AVE
LONGWOOD FL
32750-4168
US

IV. Provider business mailing address

43 WHITING HILL RD
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 321-207-0172
  • Fax: 321-207-0175
Mailing address:
  • Phone: 207-973-6605
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME160017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: