Healthcare Provider Details

I. General information

NPI: 1457814436
Provider Name (Legal Business Name): ADANNA UDEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E NEW HAVEN AVE
MELBOURNE FL
32901-5427
US

IV. Provider business mailing address

502 E NEW HAVEN AVE
MELBOURNE FL
32901-5427
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-2020
  • Fax: 321-727-4074
Mailing address:
  • Phone: 321-727-2020
  • Fax: 321-726-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSTUDENT
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME169589
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.147870
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberME169589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: