Provider Demographics
NPI:1083065064
Name:OLAGUNJU, AMANDA EBUN (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:EBUN
Last Name:OLAGUNJU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:48 NEWMARKET SQ
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-2721
Mailing Address - Country:US
Mailing Address - Phone:757-825-8030
Mailing Address - Fax:757-847-9149
Practice Address - Street 1:48 NEWMARKET SQ
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-2721
Practice Address - Country:US
Practice Address - Phone:757-825-8030
Practice Address - Fax:757-847-9149
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7732207Q00000X
VA0102207707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine