MEDICARE: AMY OGUNDARE

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1578158366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY OGUNDARE

Provider Business Mailing Address
First Line	:	2158 ELEUTHERA WAY
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-6673
Country	:	US
Telephone Number	:	302-470-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	2158 ELEUTHERA WAY
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-6673
Country	:	US
Telephone Number	:	302-470-5373
Fax Number	:

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

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	01/29/2025

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Directions to “ AMY OGUNDARE ” Practice Location

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