Provider Demographics
NPI:1184027294
Name:AMAKOM, ONYINYE
Entity Type:Individual
Prefix:
First Name:ONYINYE
Middle Name:
Last Name:AMAKOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EDELWEISS DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12789-5806
Mailing Address - Country:US
Mailing Address - Phone:845-693-4765
Mailing Address - Fax:845-693-4765
Practice Address - Street 1:3 EDELWEISS DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12789-5806
Practice Address - Country:US
Practice Address - Phone:845-693-4765
Practice Address - Fax:845-693-4765
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY676318-1163WG0600X, 163WH0200X, 163WP0808X, 163WR0400X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WW0000XNursing Service ProvidersRegistered NurseWound Care