Healthcare Provider Details

I. General information

NPI: 1093621658
Provider Name (Legal Business Name): YEYETUNDE B OLUSOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 SALTMARSH LOOP
SANFORD FL
32773-7097
US

IV. Provider business mailing address

3929 SALTMARSH LOOP
SANFORD FL
32773-7097
US

V. Phone/Fax

Practice location:
  • Phone: 321-283-4286
  • Fax:
Mailing address:
  • Phone: 321-283-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number11050077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: