Provider Demographics
NPI:1679152417
Name:OJOMO, KEHINDE O
Entity type:Individual
Prefix:
First Name:KEHINDE
Middle Name:O
Last Name:OJOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1010
Mailing Address - Country:US
Mailing Address - Phone:631-522-2647
Mailing Address - Fax:
Practice Address - Street 1:3 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-1010
Practice Address - Country:US
Practice Address - Phone:631-522-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY809614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse