Provider Demographics
NPI:1821846551
Name:ETUFUGH, DANIKE
Entity type:Individual
Prefix:MRS
First Name:DANIKE
Middle Name:
Last Name:ETUFUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 SEXTON PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2700
Mailing Address - Country:US
Mailing Address - Phone:862-262-2350
Mailing Address - Fax:
Practice Address - Street 1:1734 SEXTON PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2700
Practice Address - Country:US
Practice Address - Phone:862-262-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1804254241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist