Healthcare Provider Details

I. General information

NPI: 1710304613
Provider Name (Legal Business Name): OLUBUNMI ADEJUMOKE SHOYELE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HIGHWAY 37 W
TOMS RIVER NJ
08755-6423
US

IV. Provider business mailing address

125 PATERSON ST STE 212
NEW BRUNSWICK NJ
08901-1962
US

V. Phone/Fax

Practice location:
  • Phone: 732-557-8000
  • Fax:
Mailing address:
  • Phone: 609-206-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number25MA10825300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: