Healthcare Provider Details

I. General information

NPI: 1518441641
Provider Name (Legal Business Name): JANE OGUNSEDE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5496 E TAFT RD
NORTH SYRACUSE NY
13212-3784
US

IV. Provider business mailing address

1643 NW 136TH AVE BL H ST 100 MSC 11607-0002
SUNRISE FL
33323-2857
US

V. Phone/Fax

Practice location:
  • Phone: 315-552-6700
  • Fax: 315-552-6701
Mailing address:
  • Phone: 954-377-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343527
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF407095-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: