Healthcare Provider Details

I. General information

NPI: 1801052386
Provider Name (Legal Business Name): TAIYE AKINWANDE OGUNDIPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TURKEY HILL RD S STE 100
WESTPORT CT
06880-5525
US

IV. Provider business mailing address

1449 WHALLEY AVE UNIT 3787
NEW HAVEN CT
06525-7716
US

V. Phone/Fax

Practice location:
  • Phone: 860-918-8859
  • Fax:
Mailing address:
  • Phone: 860-918-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number51222
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number51222
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number51222
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number51222
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number51222
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number51222
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: