Healthcare Provider Details

I. General information

NPI: 1871091371
Provider Name (Legal Business Name): AYODEJI E OKORAFOR PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 MAIN ST STE 3
STURBRIDGE MA
01566-1507
US

IV. Provider business mailing address

15 STANLEY AVE
TAUNTON MA
02780-3014
US

V. Phone/Fax

Practice location:
  • Phone: 781-222-3979
  • Fax:
Mailing address:
  • Phone: 617-291-3744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2281539
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2281539
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: