Healthcare Provider Details

I. General information

NPI: 1740929645
Provider Name (Legal Business Name): MMESOMA S ANIKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MMESOMA SYLVIA ANIKE MD

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2547
  • Fax: 434-982-1893
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101289499
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101289499
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: