Provider Demographics
NPI:1881021939
Name:OKUSANYA, AYOMIDE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AYOMIDE
Middle Name:
Last Name:OKUSANYA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18302 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1623
Mailing Address - Country:US
Mailing Address - Phone:718-969-3944
Mailing Address - Fax:
Practice Address - Street 1:18302 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1623
Practice Address - Country:US
Practice Address - Phone:718-969-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY470069101103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool