Healthcare Provider Details

I. General information

NPI: 1265294284
Provider Name (Legal Business Name): OSAGIATE PRUDENCE EHI-ADOGHE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PROSPECT ST
MILFORD MA
01757-3003
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-1190
  • Fax: 508-334-6063
Mailing address:
  • Phone: 978-942-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA100328
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA100328
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: