Provider Demographics
NPI:1376774091
Name:ATANDEYI, OLUFUNMILOLA KEHINDE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:OLUFUNMILOLA
Middle Name:KEHINDE
Last Name:ATANDEYI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:OLUFUNMILOLA
Other - Middle Name:KEHINDE
Other - Last Name:FAPOHUNDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:640 MIX AVE
Mailing Address - Street 2:APT 2B
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2352
Mailing Address - Country:US
Mailing Address - Phone:302-438-1028
Mailing Address - Fax:
Practice Address - Street 1:687 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3774
Practice Address - Country:US
Practice Address - Phone:203-932-6481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004115363LF0000X
TX747246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily