Healthcare Provider Details

I. General information

NPI: 1679833552
Provider Name (Legal Business Name): ADAORA CHIOMA AKABALU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BRUCE LN
BRENTWOOD NY
11717-7322
US

IV. Provider business mailing address

31 BRUCE LN
BRENTWOOD NY
11717-7322
US

V. Phone/Fax

Practice location:
  • Phone: 631-456-8130
  • Fax:
Mailing address:
  • Phone: 631-456-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number6489241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: