Provider Demographics
NPI:1649333071
Name:OJO-ONIYUN, SAHEED GBOLAHAN (MD)
Entity type:Individual
Prefix:DR
First Name:SAHEED
Middle Name:GBOLAHAN
Last Name:OJO-ONIYUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MOORE RD UNIT 348
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1246
Mailing Address - Country:US
Mailing Address - Phone:615-545-2897
Mailing Address - Fax:
Practice Address - Street 1:750 MOORE RD UNIT 348
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1246
Practice Address - Country:US
Practice Address - Phone:615-545-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063082A174400000X
OH35.093146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV5657AMedicare PIN