Healthcare Provider Details

I. General information

NPI: 1326547613
Provider Name (Legal Business Name): TEMITOPE SHODEINDE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 LIBRARY LN
MAMARONECK NY
10543-3608
US

IV. Provider business mailing address

1276 FULTON AVE
BRONX NY
10456-3467
US

V. Phone/Fax

Practice location:
  • Phone: 914-670-1156
  • Fax:
Mailing address:
  • Phone: 718-992-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406584
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: