Provider Demographics
NPI:1003292988
Name:THOMASOGUNDEINDE, ABOSEDE ADETOUN (LPN)
Entity Type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:ADETOUN
Last Name:THOMASOGUNDEINDE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2602
Mailing Address - Country:US
Mailing Address - Phone:518-409-9322
Mailing Address - Fax:
Practice Address - Street 1:303 MAIN ST
Practice Address - Street 2:APT 241
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-1427
Practice Address - Country:US
Practice Address - Phone:518-409-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315975164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse