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General NPI Number Information
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NPI Number | 1871091371
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Entity Type | Individual
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Provider Name | AYODEJI E OKORAFOR PMHNP
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Gender | Male
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 58 MAIN ST STE 3
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City | STURBRIDGE
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State | MA
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Zip | 01566-1507
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Country | US
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Telephone | 781-222-3979
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Fax |
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Provider Business Mailing Address
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Address Line | 15 STANLEY AVE
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City | TAUNTON
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State | MA
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Zip | 02780-3014
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Country | US
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Telephone | 617-291-3744
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN2281539
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2281539
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License Number State | MA
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