Provider Demographics
NPI:1821268608
Name:ODENIYI, OLAYEMI A
Entity type:Individual
Prefix:MRS
First Name:OLAYEMI
Middle Name:A
Last Name:ODENIYI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:OLAYEMI
Other - Middle Name:A
Other - Last Name:OGUTUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 KERR RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5826
Mailing Address - Country:US
Mailing Address - Phone:845-298-0088
Mailing Address - Fax:
Practice Address - Street 1:36 KERR RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5826
Practice Address - Country:US
Practice Address - Phone:845-298-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405445-01363LP0808X
NY559079-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse