Healthcare Provider Details

I. General information

NPI: 1083229538
Provider Name (Legal Business Name): FELIX IYINBOR OSAWARU PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ELLICOTT ST UNIT 337
BUFFALO NY
14203-1547
US

IV. Provider business mailing address

5654 W BELL RD STE C
GLENDALE AZ
85308-3882
US

V. Phone/Fax

Practice location:
  • Phone: 480-803-1066
  • Fax:
Mailing address:
  • Phone: 480-803-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403048
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: