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: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PHILADELPHIA PIKE
WILMINGTON DE
19809-2100
US

IV. Provider business mailing address

260 CHRISTIANA RD APT E13
NEW CASTLE DE
19720-2967
US

V. Phone/Fax

Practice location:
  • Phone: 302-575-9702
  • Fax:
Mailing address:
  • Phone: 443-374-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-463488
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: