Provider Demographics
NPI:1679833552
Name:AKABALU, ADAORA CHIOMA (RN)
Entity Type:Individual
Prefix:MS
First Name:ADAORA
Middle Name:CHIOMA
Last Name:AKABALU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BRUCE LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7322
Mailing Address - Country:US
Mailing Address - Phone:631-456-8130
Mailing Address - Fax:
Practice Address - Street 1:31 BRUCE LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7322
Practice Address - Country:US
Practice Address - Phone:631-456-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6489241163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health