Provider Demographics
NPI:1275059321
Name:ADEDIJI, OMOLARA RACHAEL (RN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:OMOLARA
Middle Name:RACHAEL
Last Name:ADEDIJI
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 TRANTOR PL APT 1D
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1974
Mailing Address - Country:US
Mailing Address - Phone:646-353-2238
Mailing Address - Fax:
Practice Address - Street 1:210 TRANTOR PLACE
Practice Address - Street 2:APT 1D
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302
Practice Address - Country:US
Practice Address - Phone:646-353-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily