Provider Demographics
NPI:1003331703
Name:KEHINDE, OLUBUKOLA ABISOLA
Entity Type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:ABISOLA
Last Name:KEHINDE
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 1:2024 MOHEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-1734
Mailing Address - Country:US
Mailing Address - Phone:718-823-4101
Mailing Address - Fax:
Practice Address - Street 1:2024 MOHEGAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1734
Practice Address - Country:US
Practice Address - Phone:718-823-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY528997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse