Provider Demographics
NPI:1538948658
Name:BAMITEKO, OLUFUNMILAYO FOLASHADE (CRNP( PMHNP))
Entity type:Individual
Prefix:
First Name:OLUFUNMILAYO
Middle Name:FOLASHADE
Last Name:BAMITEKO
Suffix:
Gender:F
Credentials:CRNP( PMHNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1117
Mailing Address - Country:US
Mailing Address - Phone:267-968-0205
Mailing Address - Fax:
Practice Address - Street 1:2600 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2799
Practice Address - Country:US
Practice Address - Phone:215-878-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027646363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health