Provider Demographics
NPI:1174498307
Name:FALORE, CHRISTIANAH FUNMILAYO II
Entity type:Individual
Prefix:
First Name:CHRISTIANAH
Middle Name:FUNMILAYO
Last Name:FALORE
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 TRANTOR PL APT 3A
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1911
Mailing Address - Country:US
Mailing Address - Phone:312-912-4817
Mailing Address - Fax:
Practice Address - Street 1:165 TRANTOR PL APT 3A
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1911
Practice Address - Country:US
Practice Address - Phone:312-912-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352871164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse