Provider Demographics
NPI:1730898222
Name:AKUKALIA, ROSELYN NWABUGO
Entity type:Individual
Prefix:
First Name:ROSELYN
Middle Name:NWABUGO
Last Name:AKUKALIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSELYN
Other - Middle Name:NWABUGO
Other - Last Name:OKWAMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:529 BEACH 20TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3615
Mailing Address - Country:US
Mailing Address - Phone:718-327-7307
Mailing Address - Fax:
Practice Address - Street 1:529 BEACH 20TH ST STE 2
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3615
Practice Address - Country:US
Practice Address - Phone:718-327-7307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP110527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine