Healthcare Provider Details

I. General information

NPI: 1811181696
Provider Name (Legal Business Name): SOSUNMOLU OPEMEMI SHOYINKA MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S WARNER RD STE 130
KING OF PRUSSIA PA
19406-2830
US

IV. Provider business mailing address

150 S WARNER RD STE 130
KING OF PRUSSIA PA
19406-2830
US

V. Phone/Fax

Practice location:
  • Phone: 610-400-4885
  • Fax: 610-273-5542
Mailing address:
  • Phone: 610-400-4885
  • Fax: 610-273-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0437211
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2010014088
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number61826
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD468458
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301500734
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20693
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: