Provider Demographics
NPI:1346503232
Name:CHUKWUEMEKA, SHARON ICILDA
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ICILDA
Last Name:CHUKWUEMEKA
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 1:115 E MOSHOLU PKWY N
Mailing Address - Street 2:B 32
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2923
Mailing Address - Country:US
Mailing Address - Phone:347-662-9698
Mailing Address - Fax:
Practice Address - Street 1:535 8TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4305
Practice Address - Country:US
Practice Address - Phone:212-787-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330468031103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XMedicaid