Healthcare Provider Details

I. General information

NPI: 1134070733
Provider Name (Legal Business Name): ISAAC OLUSEGUN AJAYI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 ORFORD ST
WEST HAVEN CT
06516-2566
US

IV. Provider business mailing address

157 ORFORD ST
WEST HAVEN CT
06516-2566
US

V. Phone/Fax

Practice location:
  • Phone: 203-390-7612
  • Fax:
Mailing address:
  • Phone: 203-390-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: