Provider Demographics
NPI:1235194325
Name:OMORUYI, AYE (PA-C)
Entity Type:Individual
Prefix:
First Name:AYE
Middle Name:
Last Name:OMORUYI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AYE
Other - Middle Name:
Other - Last Name:OSAMWONYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:ONE HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904
Mailing Address - Country:US
Mailing Address - Phone:203-276-7298
Mailing Address - Fax:203-276-4842
Practice Address - Street 1:ONE HOSPITAL PLAZA
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06904
Practice Address - Country:US
Practice Address - Phone:203-276-7298
Practice Address - Fax:203-276-4842
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP68137Medicare UPIN
CTP68137Medicare UPIN