Healthcare Provider Details

I. General information

NPI: 1972121218
Provider Name (Legal Business Name): CENTIA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8016 STATE LINE RD STE 205
PRAIRIE VILLAGE KS
66208-3713
US

IV. Provider business mailing address

150 S WARNER RD STE 130
KING OF PRUSSIA PA
19406-2826
US

V. Phone/Fax

Practice location:
  • Phone: 610-400-4885
  • Fax: 610-273-5542
Mailing address:
  • Phone: 610-400-4885
  • Fax: 610-273-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SOSUNMOLU OPEYEMI SHOYINKA
Title or Position: FOUNDER, CHIEF MEDICAL OFFICER
Credential: MD
Phone: 917-589-4879