Healthcare Provider Details

I. General information

NPI: 1518667617
Provider Name (Legal Business Name): TEMITOPE OBASEKOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 HIGHLAND AVE
NEEDHAM MA
02494-3025
US

IV. Provider business mailing address

163 HIGHLAND AVE
NEEDHAM MA
02494-3025
US

V. Phone/Fax

Practice location:
  • Phone: 857-265-1063
  • Fax:
Mailing address:
  • Phone: 857-265-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberMCS010215B
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2323954
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2323954
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: