Provider Demographics
NPI:1013373752
Name:AIYEKU, TOLANI IYIOLA (CRNA)
Entity Type:Individual
Prefix:
First Name:TOLANI
Middle Name:IYIOLA
Last Name:AIYEKU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11413 202ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2812
Mailing Address - Country:US
Mailing Address - Phone:347-495-6628
Mailing Address - Fax:
Practice Address - Street 1:11413 202ND ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2812
Practice Address - Country:US
Practice Address - Phone:347-495-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219804367500000X
NY702305367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty