=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245158542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRIOTIC VIRTUAL TELEHEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 176 NW 25TH ST UNIT 602
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127-4594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-767-6845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 176 NW 25TH ST UNIT 602
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127-4594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RADIOLOGIST
-----------------------------------------------------
Name | DR. OLALESI OSUNSADE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 202-412-8078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------