Healthcare Provider Details

I. General information

NPI: 1902747934
Provider Name (Legal Business Name): OVIE ODIETE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NEW KARNER RD STE 9
ALBANY NY
12205-3882
US

IV. Provider business mailing address

501 NEW KARNER RD STE 9
ALBANY NY
12205-3882
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-3614
  • Fax:
Mailing address:
  • Phone: 518-456-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: