Provider Demographics
NPI:1134689706
Name:SOYEMI, TEMITOPE O (MD)
Entity type:Individual
Prefix:DR
First Name:TEMITOPE
Middle Name:O
Last Name:SOYEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TEMITOPE
Other - Middle Name:O
Other - Last Name:OLUGBODI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2020 WANTAGH AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3931
Mailing Address - Country:US
Mailing Address - Phone:516-961-4545
Mailing Address - Fax:
Practice Address - Street 1:2020 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3931
Practice Address - Country:US
Practice Address - Phone:516-961-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3263862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology