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NPI Code Detail

MEDICARE: MRS. OLUWATOMILAYO OLAPEJU DESALU MS, CNS,CDN

MEDICARE: MRS. OLUWATOMILAYO OLAPEJU DESALU MS, CNS,CDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1132700000XDietary Manager009908NY

General Provider Information

NPI Number : 1154961498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. OLUWATOMILAYO OLAPEJU DESALU MS, CNS,CDN
Provider Business Mailing Address
First Line : 460 ANDES RD
Second Line :
City : DELHI
State : NY
Zip : 13753-7443
Country : US
Telephone Number : 607-746-0300
Fax Number :
Provider Business Practice Location Address
First Line : 460 ANDES RD
Second Line :
City : DELHI
State : NY
Zip : 13753-7443
Country : US
Telephone Number : 607-746-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2020
Last Update Date : 01/15/2020

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