Provider Demographics
NPI:1992180483
Name:CUDJOE, GINEEN AFEISHA THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:GINEEN
Middle Name:AFEISHA THERESA
Last Name:CUDJOE
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 1:43 WHITING HILL RD
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-6605
Mailing Address - Fax:
Practice Address - Street 1:175 W PINE AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4168
Practice Address - Country:US
Practice Address - Phone:321-207-0172
Practice Address - Fax:321-207-0175
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME160017208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118690100Medicaid