Healthcare Provider Details

I. General information

NPI: 1881247385
Provider Name (Legal Business Name): OLUSOLA ADEKUNLE OBASA FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

IV. Provider business mailing address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-6481
  • Fax:
Mailing address:
  • Phone: 203-932-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.008303
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: