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General NPI Number Information
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NPI Number | 1376774091
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Entity Type | Individual
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Provider Name | OLUFUNMILOLA KEHINDE ATANDEYI FNP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 687 CAMPBELL AVE
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City | WEST HAVEN
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State | CT
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Zip | 06516-3774
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Country | US
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Telephone | 203-932-6481
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Fax |
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Provider Business Mailing Address
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Address Line | 640 MIX AVE APT 2B
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City | HAMDEN
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State | CT
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Zip | 06514-2352
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Country | US
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Telephone | 302-438-1028
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 004115
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 747246
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License Number State | TX
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