Provider Demographics
NPI:1144913427
Name:OLAORE, OLUYEMI ALABI
Entity type:Individual
Prefix:
First Name:OLUYEMI
Middle Name:ALABI
Last Name:OLAORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3702
Mailing Address - Country:US
Mailing Address - Phone:215-941-0658
Mailing Address - Fax:267-285-1133
Practice Address - Street 1:700 ATWOOD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3702
Practice Address - Country:US
Practice Address - Phone:215-941-0658
Practice Address - Fax:267-285-1133
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027555363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health