Provider Demographics
NPI:1770095788
Name:OBASANYA, JOSEPH ADEDEJI (FNP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ADEDEJI
Last Name:OBASANYA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3042
Mailing Address - Country:US
Mailing Address - Phone:302-983-4244
Mailing Address - Fax:
Practice Address - Street 1:1601 MILLTOWN RD STE 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4047
Practice Address - Country:US
Practice Address - Phone:302-463-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily