Healthcare Provider Details

I. General information

NPI: 1821767328
Provider Name (Legal Business Name): SHAMYRA P OSANYINLUSI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEW DURHAM RD
METUCHEN NJ
08840-1724
US

IV. Provider business mailing address

370 NEW BRUNSWICK AVE
FORDS NJ
08863-2141
US

V. Phone/Fax

Practice location:
  • Phone: 732-902-2181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01113000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: