Provider Demographics
NPI:1467914127
Name:OSOSANYA, ADEYINKA RITA
Entity Type:Individual
Prefix:
First Name:ADEYINKA
Middle Name:RITA
Last Name:OSOSANYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 FIDDLERS RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8731
Mailing Address - Country:US
Mailing Address - Phone:757-746-9686
Mailing Address - Fax:
Practice Address - Street 1:3425 FIDDLERS RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-8731
Practice Address - Country:US
Practice Address - Phone:757-746-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177391363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health