Healthcare Provider Details

I. General information

NPI: 1275172439
Provider Name (Legal Business Name): EMILY MVUDUDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2020
Last Update Date: 01/04/2020
Certification Date: 01/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 35TH AVE APT 1C
JACKSON HEIGHTS NY
11372-4935
US

IV. Provider business mailing address

8008 35TH AVE APT 1C
JACKSON HEIGHTS NY
11372-4935
US

V. Phone/Fax

Practice location:
  • Phone: 968-770-9424
  • Fax:
Mailing address:
  • Phone: 978-770-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number776522
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: