MEDICARE: ADEBISI OLUMUYIWA OSIBOGUN

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	101Y00000X	Counselor		VA

General Provider Information

NPI Number	:	1942725429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEBISI OLUMUYIWA OSIBOGUN

Provider Business Mailing Address
First Line	:	1109 LOVE CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5011
Country	:	US
Telephone Number	:	757-450-5915
Fax Number	:	757-420-1643

Provider Business Practice Location Address
First Line	:	1109 LOVE CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5011
Country	:	US
Telephone Number	:	757-450-5915
Fax Number	:	757-420-1643

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	07/21/2022

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Directions to “ ADEBISI OLUMUYIWA OSIBOGUN ” Practice Location

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