Healthcare Provider Details

I. General information

NPI: 1649500158
Provider Name (Legal Business Name): OLUKAYODE OLUSEUN ONASANYA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 N ELM ST STE 104
GREENSBORO NC
27455-2881
US

IV. Provider business mailing address

3820 N ELM ST STE 104
GREENSBORO NC
27455-2881
US

V. Phone/Fax

Practice location:
  • Phone: 336-365-1001
  • Fax: 336-897-1533
Mailing address:
  • Phone: 336-365-1001
  • Fax: 336-897-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberN/A
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number201100255
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2011-00255
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: