Healthcare Provider Details

I. General information

NPI: 1154053064
Provider Name (Legal Business Name): CHIAMAKA UKAMAKA EZEOKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 W SLAUGHTER LN STE 490
AUSTIN TX
78748-6208
US

IV. Provider business mailing address

6210 E HWY 290
AUSTIN TX
78723-1142
US

V. Phone/Fax

Practice location:
  • Phone: 512-282-8967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV7508
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: