Healthcare Provider Details

I. General information

NPI: 1194645358
Provider Name (Legal Business Name): CHARITY OYIBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 VAN WAGNER RD
POUGHKEEPSIE NY
12603-1629
US

IV. Provider business mailing address

63 VAN WAGNER RD
POUGHKEEPSIE NY
12603-1629
US

V. Phone/Fax

Practice location:
  • Phone: 845-762-6242
  • Fax:
Mailing address:
  • Phone: 845-762-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: