Provider Demographics
NPI:1356024517
Name:AMAYO, OSAHON
Entity type:Individual
Prefix:
First Name:OSAHON
Middle Name:
Last Name:AMAYO
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 1:250 MOUNT VERNON PLACE, APARTMENT 1J
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106
Mailing Address - Country:US
Mailing Address - Phone:347-459-0613
Mailing Address - Fax:
Practice Address - Street 1:250 MOUNT VERNON PLACE, APARTMENT 1J
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106
Practice Address - Country:US
Practice Address - Phone:347-459-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251C00000X373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty