Provider Demographics
NPI:1518109859
Name:CHUKWUMAH, LETITIA DANIELLE (MD)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:DANIELLE
Last Name:CHUKWUMAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:L.
Other - Middle Name:DANIELLE
Other - Last Name:CHUKWUMAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1802 REDCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1154
Mailing Address - Country:US
Mailing Address - Phone:850-283-7511
Mailing Address - Fax:
Practice Address - Street 1:7808 CLODUS FIELDS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2206
Practice Address - Country:US
Practice Address - Phone:972-770-1032
Practice Address - Fax:469-484-2126
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ84552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry