Healthcare Provider Details

I. General information

NPI: 1013712058
Provider Name (Legal Business Name): CHINWENDU NICOLETTE NGWADOM MPH, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 GEORGIA AVE STE 450
SILVER SPRING MD
20910-4962
US

IV. Provider business mailing address

1510 N CAPITOL ST NW UNIT 303
WASHINGTON DC
20002-6868
US

V. Phone/Fax

Practice location:
  • Phone: 240-863-2282
  • Fax:
Mailing address:
  • Phone: 919-827-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: