Healthcare Provider Details

I. General information

NPI: 1235891482
Provider Name (Legal Business Name): ADEBISI TOMI TIJANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E BOSTON POST RD
MAMARONECK NY
10543-3708
US

IV. Provider business mailing address

13326 RISING BLUFF LN
CYPRESS TX
77429-6276
US

V. Phone/Fax

Practice location:
  • Phone: 312-363-9143
  • Fax:
Mailing address:
  • Phone: 914-315-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10049646
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: