Provider Demographics
NPI:1942090964
Name:ETTEYIT, UWEMEDIMO
Entity type:Individual
Prefix:
First Name:UWEMEDIMO
Middle Name:
Last Name:ETTEYIT
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 1:769 E MASTEN CIR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1091
Mailing Address - Country:US
Mailing Address - Phone:302-856-4700
Mailing Address - Fax:
Practice Address - Street 1:769 E MASTEN CIR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1091
Practice Address - Country:US
Practice Address - Phone:302-856-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)