Provider Demographics
NPI:1134860208
Name:OGUNLEYE, ADETINUKE MOTUNRAYO (PA-C)
Entity type:Individual
Prefix:
First Name:ADETINUKE
Middle Name:MOTUNRAYO
Last Name:OGUNLEYE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3479 FORESTDALE DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8210
Mailing Address - Country:US
Mailing Address - Phone:631-219-3973
Mailing Address - Fax:
Practice Address - Street 1:874 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3102
Practice Address - Country:US
Practice Address - Phone:718-571-9372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001012172363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical