Provider Demographics
NPI:1487020962
Name:OTOO, CECILIA (NP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:OTOO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:ADJELEY
Other - Last Name:AYEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7007 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3657
Mailing Address - Country:US
Mailing Address - Phone:757-215-2784
Mailing Address - Fax:757-215-2728
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:757-396-6347
Practice Address - Fax:757-215-0177
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05149OtherMEDICARE GROUP PTAN