Provider Demographics
NPI:1316656127
Name:SOBE UDUAGHAN, MESODE (APRN)
Entity type:Individual
Prefix:
First Name:MESODE
Middle Name:
Last Name:SOBE UDUAGHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 US 9
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4215
Mailing Address - Country:US
Mailing Address - Phone:732-431-5300
Mailing Address - Fax:732-431-5301
Practice Address - Street 1:4345 US 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4215
Practice Address - Country:US
Practice Address - Phone:732-431-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01400000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health