Healthcare Provider Details

I. General information

NPI: 1386550671
Provider Name (Legal Business Name): OLOLADE THOMAS-OLAJIRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLOLADE THOMAS RN

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S BROADWAY
YONKERS NY
10705-2008
US

IV. Provider business mailing address

349 HAWTHORNE TER
MOUNT VERNON NY
10552-2429
US

V. Phone/Fax

Practice location:
  • Phone: 347-842-2269
  • Fax:
Mailing address:
  • Phone: 516-859-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number804953
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: