Provider Demographics
NPI:1629206743
Name:UKABI, MOJISOLA GLADYS (MD)
Entity Type:Individual
Prefix:DR
First Name:MOJISOLA
Middle Name:GLADYS
Last Name:UKABI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOJISOLA
Other - Middle Name:GLADYS
Other - Last Name:UKABI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8 AVALON WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1661
Mailing Address - Country:US
Mailing Address - Phone:713-213-2955
Mailing Address - Fax:
Practice Address - Street 1:401 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2037
Practice Address - Country:US
Practice Address - Phone:203-775-6365
Practice Address - Fax:203-740-3010
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62160207Q00000X
TXQ0197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine