Healthcare Provider Details

I. General information

NPI: 1811004443
Provider Name (Legal Business Name): YETUNDE OGUNLEYE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3528 DODGE ST
OMAHA NE
68131-3202
US

IV. Provider business mailing address

16405 MASON ST
OMAHA NE
68118-2729
US

V. Phone/Fax

Practice location:
  • Phone: 402-345-8828
  • Fax:
Mailing address:
  • Phone: 646-522-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23782
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: