Healthcare Provider Details

I. General information

NPI: 1265782536
Provider Name (Legal Business Name): SUSAN CHUKWUCHEBEANYI UYANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COMPUTER DR W STE 105
ALBANY NY
12205-1632
US

IV. Provider business mailing address

3 COMPUTER DR W STE 105
ALBANY NY
12205-1632
US

V. Phone/Fax

Practice location:
  • Phone: 518-818-0001
  • Fax:
Mailing address:
  • Phone: 518-818-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number265440
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: