Provider Demographics
NPI:1578928180
Name:JUDD, OLADAYO OYEDELE
Entity Type:Individual
Prefix:
First Name:OLADAYO
Middle Name:OYEDELE
Last Name:JUDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLADAYO
Other - Middle Name:
Other - Last Name:OYEDELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 W 24TH ST APT 9A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1551
Mailing Address - Country:US
Mailing Address - Phone:617-512-2099
Mailing Address - Fax:
Practice Address - Street 1:130 WEST KINGSBRIDGE ROAD
Practice Address - Street 2:REHAB MEDICINE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1046
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-24
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2291758363LA2100X
NY431078363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care