Provider Demographics
NPI:1609838002
Name:NWACHUKWUU, JULIETTE JOY (MD)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:JOY
Last Name:NWACHUKWUU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLLEGE PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6800
Mailing Address - Country:US
Mailing Address - Phone:716-635-0688
Mailing Address - Fax:716-204-9574
Practice Address - Street 1:100 COLLEGE PKWY STE 260
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-635-0688
Practice Address - Fax:716-204-9574
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225486207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02711360Medicaid
RA9392Medicare ID - Type Unspecified
NY02711360Medicaid