Provider Demographics
NPI:1609052588
Name:MUKWAYA, GEOFFREY MUKASA (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:MUKASA
Last Name:MUKWAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FAWNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1471
Mailing Address - Country:US
Mailing Address - Phone:203-364-1854
Mailing Address - Fax:646-441-6640
Practice Address - Street 1:15 FAWNWOOD RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1471
Practice Address - Country:US
Practice Address - Phone:203-364-1854
Practice Address - Fax:646-441-6640
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics