Provider Demographics
NPI:1578039822
Name:UDUEZUE, IFEOMANNEKA SUSAN (FNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:IFEOMANNEKA
Middle Name:SUSAN
Last Name:UDUEZUE
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:DR
Other - First Name:IFEOMANNEKA
Other - Middle Name:SUSAN
Other - Last Name:IKWUKEME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CHIMNEY POINT DR
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-2291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 CHIMNEY POINT DR
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2291
Practice Address - Country:US
Practice Address - Phone:315-541-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343722363LF0000X
NY402818363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily