Provider Demographics
NPI:1376136408
Name:ALALADE, MOTUNRAYO YEWANDE
Entity Type:Individual
Prefix:MS
First Name:MOTUNRAYO
Middle Name:YEWANDE
Last Name:ALALADE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MOTUNRAYO
Other - Middle Name:YEWANDE
Other - Last Name:ALALADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:254 FRUITWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2502
Mailing Address - Country:US
Mailing Address - Phone:347-500-0576
Mailing Address - Fax:
Practice Address - Street 1:254 FRUITWOOD LN
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2502
Practice Address - Country:US
Practice Address - Phone:347-500-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334618164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse