Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 403634 | NY |
NPI | 1013683721 |
---|---|
Provider Name | Olumide Oyeleye |
First Address | Deer Park, NY 11729-1229 |
Second Address | Deer Park, NY 11729-1229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2021 |
Last Update Date | 22/08/2021 |