Provider Demographics
NPI:1689744260
Name:AMADI, HEPSHARAT NWUGO (MD, AP)
Entity Type:Individual
Prefix:DR
First Name:HEPSHARAT
Middle Name:NWUGO
Last Name:AMADI
Suffix:
Gender:F
Credentials:MD, AP
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:DUNBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10220 W SAMPLE RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3940
Mailing Address - Country:US
Mailing Address - Phone:954-757-0064
Mailing Address - Fax:
Practice Address - Street 1:10220 W SAMPLE RD
Practice Address - Street 2:SUITE #3
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3940
Practice Address - Country:US
Practice Address - Phone:954-757-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE61834Medicare UPIN