Provider Demographics
NPI:1811319726
Name:EGUAE, ENIYE
Entity type:Individual
Prefix:
First Name:ENIYE
Middle Name:
Last Name:EGUAE
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 1:351 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-1203
Mailing Address - Country:US
Mailing Address - Phone:267-777-2999
Mailing Address - Fax:
Practice Address - Street 1:351 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-1203
Practice Address - Country:US
Practice Address - Phone:267-777-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285135-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse