Healthcare Provider Details

I. General information

NPI: 1265751010
Provider Name (Legal Business Name): ODIRI OFFIAH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ODIRI EYAGBESHARE

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CLASSON AVE APT#13H
BROOKLYN NY
11205-4342
US

IV. Provider business mailing address

325 CLASSON AVE APT#13H
BROOKLYN NY
11205-4342
US

V. Phone/Fax

Practice location:
  • Phone: 917-292-0819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407735
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1050094
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP004294
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: