Healthcare Provider Details

I. General information

NPI: 1457245672
Provider Name (Legal Business Name): YETUNDE A. OGUNBANWO NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WALT WHITMAN RD
HUNTINGTON STATION NY
11746-3612
US

IV. Provider business mailing address

15 WALT WHITMAN RD
HUNTINGTON STATION NY
11746-3612
US

V. Phone/Fax

Practice location:
  • Phone: 917-530-2366
  • Fax:
Mailing address:
  • Phone: 917-530-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YETUNDE ADENIKE OGUNBANWO
Title or Position: CEO
Credential: DNP
Phone: 917-530-2366