Provider Demographics
NPI:1154961498
Name:DESALU, OLUWATOMILAYO OLAPEJU (MS, CNS,CDN)
Entity type:Individual
Prefix:MRS
First Name:OLUWATOMILAYO
Middle Name:OLAPEJU
Last Name:DESALU
Suffix:
Gender:F
Credentials:MS, CNS,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 ANDES RD
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-7443
Mailing Address - Country:US
Mailing Address - Phone:607-746-0300
Mailing Address - Fax:
Practice Address - Street 1:460 ANDES RD
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-7443
Practice Address - Country:US
Practice Address - Phone:607-746-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009908132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager