Provider Demographics
NPI:1356415970
Name:ODEDOSU, TAIYE O (MD)
Entity type:Individual
Prefix:DR
First Name:TAIYE
Middle Name:O
Last Name:ODEDOSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 95TH ST APT 20K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4007
Mailing Address - Country:US
Mailing Address - Phone:917-952-9562
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVENUE, 27TH STREET, BELLEVUE HOSPITAL
Practice Address - Street 2:MODULE C,
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-562-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238193207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY251296OtherMDID