Healthcare Provider Details

I. General information

NPI: 1770421836
Provider Name (Legal Business Name): DAVID TUNDE OLADOSU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CHERRY DR W
PLAINVIEW NY
11803-2806
US

IV. Provider business mailing address

118 CHERRY DR W
PLAINVIEW NY
11803-2806
US

V. Phone/Fax

Practice location:
  • Phone: 310-948-3969
  • Fax: 310-948-3969
Mailing address:
  • Phone: 310-948-3969
  • Fax: 310-948-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: