Healthcare Provider Details

I. General information

NPI: 1003164377
Provider Name (Legal Business Name): EJINE OKOROAFOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 W SAHARA AVE SUITE 202
LAS VEGAS NV
89146-0355
US

IV. Provider business mailing address

5440 W SAHARA AVE SUITE 202
LAS VEGAS NV
89146-0355
US

V. Phone/Fax

Practice location:
  • Phone: 914-426-7774
  • Fax:
Mailing address:
  • Phone: 914-426-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15734
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: