Provider Demographics
NPI:1043489651
Name:ADESANYA, KUDIRAT OLUFUNKE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:KUDIRAT
Middle Name:OLUFUNKE
Last Name:ADESANYA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1620
Mailing Address - Country:US
Mailing Address - Phone:631-698-2599
Mailing Address - Fax:631-698-2599
Practice Address - Street 1:8 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1620
Practice Address - Country:US
Practice Address - Phone:631-698-2599
Practice Address - Fax:631-698-2599
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY589415 1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse