Individual
CHINYELU LILY FAFOWORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21038 NASHVILLE BLVD, CAMBRIA HTS, NY 11411-1043
(646) 262-0168
Mailing address
21038 NASHVILLE BLVD, CAMBRIA HTS, NY 11411-1043
(646) 262-0168
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1114570
NY
Other
Enumeration date
08/27/2012
Last updated
08/27/2012
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