Healthcare Provider Details

I. General information

NPI: 1437503323
Provider Name (Legal Business Name): OLUBUSOLA AMIOLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 VOLVO PKWY STE 310
CHESAPEAKE VA
23320-1610
US

IV. Provider business mailing address

733 VOLVO PKWY STE 310
CHESAPEAKE VA
23320-1610
US

V. Phone/Fax

Practice location:
  • Phone: 757-347-4531
  • Fax: 844-689-9301
Mailing address:
  • Phone: 757-347-4531
  • Fax: 844-689-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number322669
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101271938
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD20258
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD491119
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number322669
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA13091500
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01094554A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: