Provider Demographics
NPI:1851276802
Name:UDEH, SHALOM CHEKWUBECHUKWU
Entity type:Individual
Prefix:
First Name:SHALOM
Middle Name:CHEKWUBECHUKWU
Last Name:UDEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHALOM
Other - Middle Name:C
Other - Last Name:UDEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:655 WASHINGTON ST APT 239
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-3449
Mailing Address - Country:US
Mailing Address - Phone:774-434-2176
Mailing Address - Fax:
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10005515163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse