MEDICARE: OLUFUNMILAYO FOLASHADE BAMITEKO CRNP( PMHNP)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP027646	PA

General Provider Information

NPI Number	:	1538948658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUFUNMILAYO FOLASHADE BAMITEKO CRNP( PMHNP)

Provider Business Mailing Address
First Line	:	16 SYCAMORE AVE
Second Line	:
City	:	MORTON
State	:	PA
Zip	:	19070-1117
Country	:	US
Telephone Number	:	267-968-0205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 BELMONT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2799
Country	:	US
Telephone Number	:	215-878-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	09/27/2023

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