Provider Demographics
NPI:1386805919
Name:UFONDU, NDIDI (DPM)
Entity type:Individual
Prefix:DR
First Name:NDIDI
Middle Name:
Last Name:UFONDU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:NDIDI
Other - Middle Name:
Other - Last Name:UKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 210773
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-7773
Mailing Address - Country:US
Mailing Address - Phone:817-330-9698
Mailing Address - Fax:
Practice Address - Street 1:319 OSLER DR STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5407
Practice Address - Country:US
Practice Address - Phone:817-538-5291
Practice Address - Fax:682-238-0738
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00296800213EP1101X, 213ES0103X
TX3008213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1I7588OtherMEDICARE
TX4215576Medicaid
TX4217457Medicaid
TX1I7599OtherMEDICARE
TX7869550001OtherPALMETTO GBA - NSC DME