Provider Demographics
NPI:1639660061
Name:OLOGUNJA, TAIYE ROSELYN
Entity Type:Individual
Prefix:
First Name:TAIYE
Middle Name:ROSELYN
Last Name:OLOGUNJA
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 1:100 DEBS PL APT 15E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2512
Mailing Address - Country:US
Mailing Address - Phone:646-579-9647
Mailing Address - Fax:
Practice Address - Street 1:100 DEBS PL APT 15E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2512
Practice Address - Country:US
Practice Address - Phone:646-579-9647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty