Provider Demographics
NPI:1679052450
Name:OLAOLU, OLALEKAN IFEOLUWA
Entity Type:Individual
Prefix:DR
First Name:OLALEKAN
Middle Name:IFEOLUWA
Last Name:OLAOLU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:OLALEKAN
Other - Middle Name:IFEOLUWA
Other - Last Name:OLAIFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 O'BRIEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1805
Mailing Address - Country:US
Mailing Address - Phone:404-399-9616
Mailing Address - Fax:
Practice Address - Street 1:70 O'BRIEN DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-12
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT717692084F0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program