Healthcare Provider Details

I. General information

NPI: 1669367827
Provider Name (Legal Business Name): MICHAEL OKUNFOLAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 BENEFIT ST. WESTBAY COMMUNITY ACTION
PROVIDENCE RI
02904
US

IV. Provider business mailing address

224 BUTTONWOODS AVE
WARWICK RI
02886-7541
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-4666
  • Fax:
Mailing address:
  • Phone: 401-921-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: