Healthcare Provider Details

I. General information

NPI: 1295657062
Provider Name (Legal Business Name): OKWUCHI UCHEOMA UKEGBU AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W SUNRISE HWY FL 3
VALLEY STREAM NY
11581-1011
US

IV. Provider business mailing address

338 RICHARD AVE APT A1
HICKSVILLE NY
11801-1234
US

V. Phone/Fax

Practice location:
  • Phone: 718-732-4049
  • Fax:
Mailing address:
  • Phone: 347-453-2281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433564
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: