Provider Demographics
NPI:1023275575
Name:OLANIYI, OMOLARA A (PHD, FNP, RN)
Entity type:Individual
Prefix:MRS
First Name:OMOLARA
Middle Name:A
Last Name:OLANIYI
Suffix:
Gender:F
Credentials:PHD, FNP, RN
Other - Prefix:PROF
Other - First Name:OMOLARA
Other - Middle Name:A
Other - Last Name:SERIKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 CORABELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1230
Mailing Address - Country:US
Mailing Address - Phone:347-356-4434
Mailing Address - Fax:
Practice Address - Street 1:11156 76TH DR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7057
Practice Address - Country:US
Practice Address - Phone:347-356-4434
Practice Address - Fax:718-544-0972
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333974-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner