Provider Demographics
NPI:1154620912
Name:AJAYI, OLUBUKOLA ELIZABETH (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:OLUBUKOLA
Middle Name:ELIZABETH
Last Name:AJAYI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5133
Mailing Address - Country:US
Mailing Address - Phone:347-217-0011
Mailing Address - Fax:
Practice Address - Street 1:11606 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1748
Practice Address - Country:US
Practice Address - Phone:718-850-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626867-1163W00000X
GARN302062363LP0808X
NYF4033941363LP0808X
NYF403941363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse