Provider Demographics
NPI:1376088682
Name:OSHIKANLU, OLABISI (NP-C)
Entity Type:Individual
Prefix:
First Name:OLABISI
Middle Name:
Last Name:OSHIKANLU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-7018
Mailing Address - Country:US
Mailing Address - Phone:631-747-3400
Mailing Address - Fax:
Practice Address - Street 1:1 FARMINGDALE ROAD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6235
Practice Address - Country:US
Practice Address - Phone:631-669-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307864-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health