Provider Demographics
NPI:1770470122
Name:SOGUNRO, OLAYANJU YETUNDE (NP)
Entity type:Individual
Prefix:
First Name:OLAYANJU
Middle Name:YETUNDE
Last Name:SOGUNRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CLAYTON LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1241
Mailing Address - Country:US
Mailing Address - Phone:267-577-9136
Mailing Address - Fax:
Practice Address - Street 1:9 CLAYTON LN
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-1241
Practice Address - Country:US
Practice Address - Phone:267-577-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN717708163W00000X
PASP030568363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse