Provider Demographics
NPI:1003249228
Name:CHILAKA, CHIOMA ONYEMECHI (NP)
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:ONYEMECHI
Last Name:CHILAKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY
Mailing Address - Street 2:WOODHULL MEDICAL & MENTAL HEALTH CENTER 2B230
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5317
Mailing Address - Country:US
Mailing Address - Phone:718-630-3476
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:760 BROADWAY WOODHULL MEDICAL & MENTAL HEALTH CENTER
Practice Address - Street 2:DEPARTMENT OF MEDICINE - 2C-120
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306451363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health