Provider Demographics
NPI:1952964405
Name:ONWUAMAEGBU, TEMITAYO IFEANYI (NP)
Entity type:Individual
Prefix:
First Name:TEMITAYO
Middle Name:IFEANYI
Last Name:ONWUAMAEGBU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9614 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-2110
Mailing Address - Country:US
Mailing Address - Phone:347-695-6999
Mailing Address - Fax:
Practice Address - Street 1:765 LINCOLN AVE APT 16F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4104
Practice Address - Country:US
Practice Address - Phone:347-695-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405980363LP0808X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health