Healthcare Provider Details

I. General information

NPI: 1922764976
Provider Name (Legal Business Name): MARY ONYECHEFUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16022 110TH AVE
JAMAICA NY
11433-3224
US

IV. Provider business mailing address

16022 110TH AVE
JAMAICA NY
11433-3224
US

V. Phone/Fax

Practice location:
  • Phone: 347-693-4804
  • Fax:
Mailing address:
  • Phone: 347-693-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number802664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: