Healthcare Provider Details

I. General information

NPI: 1164157673
Provider Name (Legal Business Name): NYAD ADINDA-OUGBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MELROSE AVE FRNT 2L
BRONX NY
10451-5757
US

IV. Provider business mailing address

1211 SOUTHERN BLVD APT 704
BRONX NY
10459-4606
US

V. Phone/Fax

Practice location:
  • Phone: 917-473-6996
  • Fax:
Mailing address:
  • Phone: 929-454-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: