Provider Demographics
NPI:1245025253
Name:AGBEKO, ERNEST TETTEY
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:TETTEY
Last Name:AGBEKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 LAUREL AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1176
Mailing Address - Country:US
Mailing Address - Phone:203-297-7414
Mailing Address - Fax:
Practice Address - Street 1:393 LAUREL AVE APT 214
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1176
Practice Address - Country:US
Practice Address - Phone:203-297-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14682363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health