Healthcare Provider Details

I. General information

NPI: 1689417982
Provider Name (Legal Business Name): OLUWATOYIN ODUNAYO ADEGOKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 W EAGLE ST FL 5
BUFFALO NY
14202-3804
US

IV. Provider business mailing address

3581 BIG TREE RD UNIT 14
HAMBURG NY
14075-1737
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-8090
  • Fax:
Mailing address:
  • Phone: 716-398-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number720801
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1217354
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351982
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: