Provider Demographics
NPI:1124814686
Name:OYEWOLE, AYODEJI S (PMHNP)
Entity type:Individual
Prefix:
First Name:AYODEJI
Middle Name:S
Last Name:OYEWOLE
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CHESTNUT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-5577
Mailing Address - Country:US
Mailing Address - Phone:802-289-2806
Mailing Address - Fax:
Practice Address - Street 1:22 ANNA MARSH LN
Practice Address - Street 2:
Practice Address - City:DUMMERSTON
Practice Address - State:VT
Practice Address - Zip Code:05301-3292
Practice Address - Country:US
Practice Address - Phone:802-258-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0137857363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health