Healthcare Provider Details

I. General information

NPI: 1083528152
Provider Name (Legal Business Name): MS. AYOOLA AJIBOLA OGUNSINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W SEYMOUR ST
PHILADELPHIA PA
19144-4113
US

IV. Provider business mailing address

321 W SEYMOUR ST
PHILADELPHIA PA
19144-4113
US

V. Phone/Fax

Practice location:
  • Phone: 610-227-0388
  • Fax:
Mailing address:
  • Phone: 610-227-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH002615
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: