Healthcare Provider Details

I. General information

NPI: 1336930791
Provider Name (Legal Business Name): FIYINFOLUWA OMIFARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WEST ST STE 1200
WILMINGTON DE
19801-1058
US

IV. Provider business mailing address

360 DILLON CIR
MIDDLETOWN DE
19709-8401
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 443-374-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: