Provider Demographics
NPI:1861056038
Name:CHIKUNGUWO, EDINAH TENDAI (DO)
Entity type:Individual
Prefix:DR
First Name:EDINAH
Middle Name:TENDAI
Last Name:CHIKUNGUWO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3377
Mailing Address - Country:US
Mailing Address - Phone:215-746-7248
Mailing Address - Fax:215-746-7203
Practice Address - Street 1:3535 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3377
Practice Address - Country:US
Practice Address - Phone:215-746-7248
Practice Address - Fax:215-746-7203
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN000000000000002084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology