Provider Demographics
NPI:1962937789
Name:MBADUGHA, SYBIL IJEOMA AGU (MD)
Entity type:Individual
Prefix:
First Name:SYBIL
Middle Name:IJEOMA AGU
Last Name:MBADUGHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IJEOMA AGU
Other - Middle Name:
Other - Last Name:MBADUGHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2060 SPACE PARK DR STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2060 SPACE PARK DR STE 208
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3675
Practice Address - Country:US
Practice Address - Phone:713-441-6455
Practice Address - Fax:281-333-0227
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV3379207VF0040X
NC2021-01834207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology