Healthcare Provider Details

I. General information

NPI: 1679378582
Provider Name (Legal Business Name): ANUOLUWAPO OBASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SCHLEY ST
NEWARK NJ
07112-1159
US

IV. Provider business mailing address

7108 SOUTH KANNER HWY, STUART, FL 34997-7462
STUART FL
34997
US

V. Phone/Fax

Practice location:
  • Phone: 817-881-1945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: