Healthcare Provider Details

I. General information

NPI: 1659538031
Provider Name (Legal Business Name): OYEPERO GBADEBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CROWN ST APT 5A
BROOKLYN NY
11225-1822
US

IV. Provider business mailing address

49 CROWN ST APT 5A
BROOKLYN NY
11225-1822
US

V. Phone/Fax

Practice location:
  • Phone: 718-774-3351
  • Fax: 718-774-3351
Mailing address:
  • Phone: 718-774-3351
  • Fax: 718-774-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number598485-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: