Healthcare Provider Details

I. General information

NPI: 1306074281
Provider Name (Legal Business Name): MUMBI MELODY NGUGI PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
DAYTON OH
45433-5529
US

IV. Provider business mailing address

4881 SUGAR MAPLE DR
DAYTON OH
45433-5529
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-0837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1108695
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: