Provider Demographics
NPI:1891420071
Name:OSINEYE, OLATUNJI ANTHONY
Entity type:Individual
Prefix:MR
First Name:OLATUNJI
Middle Name:ANTHONY
Last Name:OSINEYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-1218
Mailing Address - Country:US
Mailing Address - Phone:617-678-0441
Mailing Address - Fax:
Practice Address - Street 1:16 ELLIS ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-1218
Practice Address - Country:US
Practice Address - Phone:617-678-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263217163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty