Healthcare Provider Details

I. General information

NPI: 1114834470
Provider Name (Legal Business Name): OLUWAFUNMILOLA AKINTAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SUFFERN PL STE A
SUFFERN NY
10901-5566
US

IV. Provider business mailing address

4022 BAYCHESTER AVE FL 2
BRONX NY
10466-2314
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN48949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: