Provider Demographics
NPI:1467992891
Name:MBADIWE, NNEKA (NP)
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:
Last Name:MBADIWE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E 206TH ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1114
Mailing Address - Country:US
Mailing Address - Phone:302-521-6128
Mailing Address - Fax:
Practice Address - Street 1:3336 FULTON ST UNIT 29
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2004
Practice Address - Country:US
Practice Address - Phone:646-347-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-05
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030792163W00000X
MN2342300163W00000X
DC1035788163W00000X
FL9352475363LP0808X
NYF309721-01363LA2200X
NY405854363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health