Provider Demographics
NPI:1932393089
Name:OFFOHA-NWOSU, NELLYZITA
Entity Type:Individual
Prefix:
First Name:NELLYZITA
Middle Name:
Last Name:OFFOHA-NWOSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NELLYZITA
Other - Middle Name:
Other - Last Name:NWOSU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12023 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1925
Mailing Address - Country:US
Mailing Address - Phone:315-383-6524
Mailing Address - Fax:
Practice Address - Street 1:12023 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1925
Practice Address - Country:US
Practice Address - Phone:315-383-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013318-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist