Provider Demographics
NPI:1144988593
Name:OVIASOGIE, ESEOSA JOY
Entity type:Individual
Prefix:MRS
First Name:ESEOSA
Middle Name:JOY
Last Name:OVIASOGIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESEOSA
Other - Middle Name:JOY
Other - Last Name:OVIASOGIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:969 ELLICOTT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:969 ELLICOTT ST STE 100
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2324
Practice Address - Country:US
Practice Address - Phone:716-908-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY825418-01163W00000X
NY407558363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse