Healthcare Provider Details

I. General information

NPI: 1760268064
Provider Name (Legal Business Name): OLUWADAMILOLA MUNIRAT TAIWO-ONIGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10816 63RD RD
FOREST HILLS NY
11375-1352
US

IV. Provider business mailing address

254 MEYER AVE
VALLEY STREAM NY
11580-3136
US

V. Phone/Fax

Practice location:
  • Phone: 516-709-4868
  • Fax:
Mailing address:
  • Phone: 516-709-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number765524
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421729-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: