Healthcare Provider Details

I. General information

NPI: 1215722293
Provider Name (Legal Business Name): CINDY OBAZUAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 BILTMORE DR APT G1
HORSEHEADS NY
14845-8137
US

IV. Provider business mailing address

81 BILTMORE DR APT G1
HORSEHEADS NY
14845-8137
US

V. Phone/Fax

Practice location:
  • Phone: 973-873-4006
  • Fax:
Mailing address:
  • Phone: 973-873-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number351897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: