Healthcare Provider Details

I. General information

NPI: 1619838877
Provider Name (Legal Business Name): CHUKWUEMEKA ONWUSILIKAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ARBORETUM WAY
BURLINGTON MA
01803-3827
US

IV. Provider business mailing address

1 SOPHIA DR
AUBURN MA
01501-3177
US

V. Phone/Fax

Practice location:
  • Phone: 240-244-4863
  • Fax: 443-513-2664
Mailing address:
  • Phone: 508-740-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025071409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: