Provider Demographics
NPI:1063645596
Name:OKEKE, CHINELLE UDO (FNP, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CHINELLE
Middle Name:UDO
Last Name:OKEKE
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:MS
Other - First Name:UDOKA
Other - Middle Name:C
Other - Last Name:OKEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:747 MADISON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3809
Mailing Address - Country:US
Mailing Address - Phone:518-772-8182
Mailing Address - Fax:518-514-1208
Practice Address - Street 1:747 MADISON AVE STE 102
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3809
Practice Address - Country:US
Practice Address - Phone:518-772-8182
Practice Address - Fax:518-514-1208
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335568363LF0000X
NY404484363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily