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NPI Code Detail

MEDICARE: VICTORIA IFEDINMA UDOCHU PA-C

MEDICARE: VICTORIA IFEDINMA UDOCHU PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-15606NC

General Provider Information

NPI Number : 1437048162
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA IFEDINMA UDOCHU PA-C
Provider Business Mailing Address
First Line : 100 KIMEL FOREST DR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-6074
Country : US
Telephone Number : 336-716-2255
Fax Number :
Provider Business Practice Location Address
First Line : 4618 COUNTRY CLUB RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27104-3520
Country : US
Telephone Number : 336-716-3926
Fax Number : 336-716-9258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2025
Last Update Date : 03/04/2026

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