Provider Demographics
NPI:1578158366
Name:OGUNDARE, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OGUNDARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 ELEUTHERA WAY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6673
Mailing Address - Country:US
Mailing Address - Phone:302-470-5373
Mailing Address - Fax:
Practice Address - Street 1:2158 ELEUTHERA WAY
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6673
Practice Address - Country:US
Practice Address - Phone:302-470-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst