Provider Demographics
NPI:1346949914
Name:FIAWUMO, AMEVI DZIGBODI
Entity Type:Individual
Prefix:
First Name:AMEVI
Middle Name:DZIGBODI
Last Name:FIAWUMO
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 1:1430 PARKCHESTER RD APT MD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7609
Mailing Address - Country:US
Mailing Address - Phone:917-969-7803
Mailing Address - Fax:
Practice Address - Street 1:1430 PARKCHESTER RD APT MD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7609
Practice Address - Country:US
Practice Address - Phone:917-969-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027556-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist