Healthcare Provider Details

I. General information

NPI: 1942456256
Provider Name (Legal Business Name): CYRIACUS UZOMA ANAELE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CYRIACUS UZOMA ANAELE M.D.

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PARK ST
HONESDALE PA
18431-1498
US

IV. Provider business mailing address

1008 N MAIN ST
SIKESTON MO
63801-5044
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-8185
  • Fax: 570-253-8348
Mailing address:
  • Phone: 573-472-7406
  • Fax: 573-472-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2010031648
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD479271
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: