Provider Demographics
NPI:1003152539
Name:FASHAKIN, FOLUKE GRACE (RN)
Entity Type:Individual
Prefix:
First Name:FOLUKE
Middle Name:GRACE
Last Name:FASHAKIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BOTSFORD ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7328
Mailing Address - Country:US
Mailing Address - Phone:718-710-7457
Mailing Address - Fax:516-307-9858
Practice Address - Street 1:107 BOTSFORD ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-7328
Practice Address - Country:US
Practice Address - Phone:718-710-7457
Practice Address - Fax:516-307-9858
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY663572163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse