Healthcare Provider Details

I. General information

NPI: 1568023828
Provider Name (Legal Business Name): MMEYENEABASI DAVID OMEDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MMEYENEABASI DAVID ESSIEN M.D.

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE STE 311
GREENSBORO NC
27401-1210
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-6161
  • Fax: 336-271-3724
Mailing address:
  • Phone:
  • 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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number292199
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number292199
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number2025-00597
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: