Provider Demographics
NPI:1316694540
Name:OYELESE, OPEYEMI (HOMEMAKER COMPANION)
Entity type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:
Last Name:OYELESE
Suffix:
Gender:F
Credentials:HOMEMAKER COMPANION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 W OAKLAND PARK BLVD UNIT 190237
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-8709
Mailing Address - Country:US
Mailing Address - Phone:954-805-5715
Mailing Address - Fax:
Practice Address - Street 1:7351 W OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-7107
Practice Address - Country:US
Practice Address - Phone:954-326-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL238400376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL238400OtherHOMEMAKER COMPANION LICENSE