Provider Demographics
NPI:1053146472
Name:NWANESIDU, CHIMA N/A
Entity type:Individual
Prefix:MR
First Name:CHIMA
Middle Name:N/A
Last Name:NWANESIDU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SCHUYLER ST # 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-2507
Mailing Address - Country:US
Mailing Address - Phone:512-412-8776
Mailing Address - Fax:
Practice Address - Street 1:35 SCHUYLER ST # 2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-2507
Practice Address - Country:US
Practice Address - Phone:512-412-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician