Individual
BENEDICTA OLAMIDE UDEAGBALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1505 53RD AVE E, BRADENTON, FL 34203-4249
(941) 357-7950
Mailing address
1395 NW 167TH ST, MIAMI GARDENS, FL 33169-5710
(941) 357-7950
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34006079
OH
207Q00000X
Family Medicine Physician
Primary
OS17771
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0241812
—
OH
Enumeration date
09/24/2006
Last updated
05/17/2021
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