Provider Demographics
NPI:1346553252
Name:SOMEFUN, SAMUEL OLADELE (RN)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:OLADELE
Last Name:SOMEFUN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 DE REIMER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2320
Mailing Address - Country:US
Mailing Address - Phone:718-496-2363
Mailing Address - Fax:347-843-8381
Practice Address - Street 1:3041 AVENUE U, 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:BROOOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-615-0049
Practice Address - Fax:718-646-5315
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY619569163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool