Healthcare Provider Details

I. General information

NPI: 1144776105
Provider Name (Legal Business Name): OLUWAFUNKE OGUNDELE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 E 140TH ST
BRONX NY
10454-2752
US

IV. Provider business mailing address

468 E 140TH ST RM 120
BRONX NY
10454-2752
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-4482
  • Fax: 718-585-5085
Mailing address:
  • Phone: 718-292-4482
  • Fax: 718-585-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number026924
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2680067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: