Provider Demographics
NPI:1093950545
Name:OSHINUBI, ABOSEDE A (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ABOSEDE
Middle Name:A
Last Name:OSHINUBI
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 LIBERTY IVES DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-2274
Mailing Address - Country:US
Mailing Address - Phone:678-516-1220
Mailing Address - Fax:
Practice Address - Street 1:4025 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE A
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2819
Practice Address - Country:US
Practice Address - Phone:770-921-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002267133NN1002X, 133V00000X, 133VN1004X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty