Provider Demographics
NPI:1033716956
Name:SHOKUNBI, TINUOLU T (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TINUOLU
Middle Name:T
Last Name:SHOKUNBI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 DANBURY DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3203
Mailing Address - Country:US
Mailing Address - Phone:202-907-4147
Mailing Address - Fax:
Practice Address - Street 1:6401 NEW HAMPSHIRE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3201
Practice Address - Country:US
Practice Address - Phone:301-466-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty