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NPI Code Detail

MEDICARE: DR. AYOMIDE OKUSANYA PSY.D.

MEDICARE: DR. AYOMIDE OKUSANYA PSY.D.
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
1103TS0200XSchool Psychologist470069101NY

General Provider Information

NPI Number : 1881021939
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AYOMIDE OKUSANYA PSY.D.
Provider Business Mailing Address
First Line : 18302 UNION TPKE
Second Line :
City : FLUSHING
State : NY
Zip : 11366-1623
Country : US
Telephone Number : 718-969-3944
Fax Number :
Provider Business Practice Location Address
First Line : 18302 UNION TPKE
Second Line :
City : FLUSHING
State : NY
Zip : 11366-1623
Country : US
Telephone Number : 718-969-3944
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2013
Last Update Date : 10/03/2013

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