Healthcare Provider Details

I. General information

NPI: 1871816819
Provider Name (Legal Business Name): DORIS ONYEBUCHI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 GRACE AVE
BRONX NY
10469-3228
US

IV. Provider business mailing address

3045 GRACE AVE
BRONX NY
10469-3228
US

V. Phone/Fax

Practice location:
  • Phone: 347-241-9967
  • Fax:
Mailing address:
  • Phone: 347-241-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberF407610-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: