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General NPI Number Information
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NPI Number | 1134860208
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Entity Type | Individual
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Provider Name | ADETINUKE MOTUNRAYO OGUNLEYE PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 874 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11226-3102
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Country | US
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Telephone | 718-571-9372
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Fax |
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Provider Business Mailing Address
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Address Line | 3479 FORESTDALE DR APT 2A
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City | BURLINGTON
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State | NC
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Zip | 27215-8210
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Country | US
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Telephone | 631-219-3973
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001012172
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001012172
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License Number State | NC
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