Provider Demographics
NPI:1417248436
Name:ONAYEMI, OLUSOLA KENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSOLA
Middle Name:KENDRA
Last Name:ONAYEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7613
Mailing Address - Country:US
Mailing Address - Phone:757-395-1300
Mailing Address - Fax:757-226-0247
Practice Address - Street 1:2859 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7613
Practice Address - Country:US
Practice Address - Phone:757-395-1300
Practice Address - Fax:757-226-0247
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256784207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVF985AMedicare PIN