Provider Demographics
NPI:1386011013
Name:SANGODINA, OLAPEJU
Entity Type:Individual
Prefix:
First Name:OLAPEJU
Middle Name:
Last Name:SANGODINA
Suffix:
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 1:1381 LINDEN BLVD APT 2K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4735
Mailing Address - Country:US
Mailing Address - Phone:347-365-2220
Mailing Address - Fax:
Practice Address - Street 1:1381 LINDEN BLVD APT 2K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4735
Practice Address - Country:US
Practice Address - Phone:347-365-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322535-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse