Provider Demographics
NPI:1962069682
Name:NGUETCHO, SILDEVIE T (DR)
Entity type:Individual
Prefix:
First Name:SILDEVIE
Middle Name:T
Last Name:NGUETCHO
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-4207
Mailing Address - Country:US
Mailing Address - Phone:973-652-3639
Mailing Address - Fax:
Practice Address - Street 1:1018 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1401
Practice Address - Country:US
Practice Address - Phone:732-561-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04006700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist