Healthcare Provider Details

I. General information

NPI: 1831033752
Provider Name (Legal Business Name): EMMANUEL CHIAGOZIE UBAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LORD BYRON CT
CHESAPEAKE VA
23320-7919
US

IV. Provider business mailing address

600 LORD BYRON CT
CHESAPEAKE VA
23320-7919
US

V. Phone/Fax

Practice location:
  • Phone: 802-565-0601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024196546
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: