Provider Demographics
NPI:1083960777
Name:ADEDUNTAN, GANIYAT (NP)
Entity Type:Individual
Prefix:
First Name:GANIYAT
Middle Name:
Last Name:ADEDUNTAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:ANESTHESIA DEPT.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-789-2782
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2782
Practice Address - Fax:781-407-0998
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2265969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily