Healthcare Provider Details

I. General information

NPI: 1154255461
Provider Name (Legal Business Name): CHUKWUDI ODIGBO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 E 99TH ST APT 2
BROOKLYN NY
11236-4065
US

IV. Provider business mailing address

928 E 99TH ST APT 2
BROOKLYN NY
11236-4065
US

V. Phone/Fax

Practice location:
  • Phone: 704-939-8419
  • Fax:
Mailing address:
  • Phone: 704-939-8419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number356239-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: