Provider Demographics
NPI:1750874202
Name:CHIBUNDU, UZOMA FIDELIS II
Entity type:Individual
Prefix:
First Name:UZOMA
Middle Name:FIDELIS
Last Name:CHIBUNDU
Suffix:II
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:PO BOX 250227
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-0227
Mailing Address - Country:US
Mailing Address - Phone:267-575-8962
Mailing Address - Fax:
Practice Address - Street 1:936 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8104
Practice Address - Country:US
Practice Address - Phone:267-575-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102921104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker