Provider Demographics
NPI:1134609159
Name:WODOME, ADJOA AHAVESSI
Entity type:Individual
Prefix:
First Name:ADJOA
Middle Name:AHAVESSI
Last Name:WODOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADJOA
Other - Middle Name:AHAVESSI
Other - Last Name:D'ALMEIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2015 SOUTHERN BLVD APT 8E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-1406
Mailing Address - Country:US
Mailing Address - Phone:646-617-3895
Mailing Address - Fax:
Practice Address - Street 1:2015 SOUTHERN BLVD APT 8E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1406
Practice Address - Country:US
Practice Address - Phone:646-617-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713724163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse