Provider Demographics
NPI:1346492105
Name:ANUSIONWU, REAGAN OBIOZOR
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:OBIOZOR
Last Name:ANUSIONWU
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 1:548 THROGGS NECK EXPY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1717
Mailing Address - Country:US
Mailing Address - Phone:917-557-6064
Mailing Address - Fax:347-287-6916
Practice Address - Street 1:548 THROGGS NECK EXPY
Practice Address - Street 2:SUITE 4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1717
Practice Address - Country:US
Practice Address - Phone:917-557-6064
Practice Address - Fax:347-287-6916
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401556363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health