Healthcare Provider Details

I. General information

NPI: 1972064087
Provider Name (Legal Business Name): NNEAMAKA UKATU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 DANIELS RD
WINTER GARDEN FL
34787-4599
US

IV. Provider business mailing address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

V. Phone/Fax

Practice location:
  • Phone: 407-395-3770
  • Fax: 407-395-3779
Mailing address:
  • Phone: 718-226-8313
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME162333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: