Provider Demographics
NPI:1215418579
Name:NNADI, HENRIETTA NWAMAKA
Entity Type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:NWAMAKA
Last Name:NNADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NWAMAKA
Other - Middle Name:HENRIETTA
Other - Last Name:NNADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22338 112TH RD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2703
Mailing Address - Country:US
Mailing Address - Phone:646-594-4631
Mailing Address - Fax:
Practice Address - Street 1:22338 112TH RD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2703
Practice Address - Country:US
Practice Address - Phone:646-594-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst