Provider Demographics
NPI:1366177255
Name:OKUNZUWA, UYI
Entity type:Individual
Prefix:
First Name:UYI
Middle Name:
Last Name:OKUNZUWA
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 1:52 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2418
Mailing Address - Country:US
Mailing Address - Phone:781-484-7320
Mailing Address - Fax:
Practice Address - Street 1:52 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2418
Practice Address - Country:US
Practice Address - Phone:781-484-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver