Individual
MOJISOLA GANIAT OMOTUNDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14805 116TH AVE, JAMAICA, NY 11436-1306
(347) 264-2034
Mailing address
14805 116TH AVE, JAMAICA, NY 11436-1306
(347) 264-2034
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
514437
NY
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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