Provider Demographics
NPI:1497332449
Name:UDEMBA, SHARON CHIZOTAM (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:CHIZOTAM
Last Name:UDEMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 AIRLINE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2650
Mailing Address - Country:US
Mailing Address - Phone:757-738-1225
Mailing Address - Fax:757-488-1037
Practice Address - Street 1:3537 AIRLINE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2650
Practice Address - Country:US
Practice Address - Phone:757-738-1225
Practice Address - Fax:757-488-1037
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101281666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty