Provider Demographics
NPI:1396379400
Name:ADESANYA, ADELEKE M (NP)
Entity Type:Individual
Prefix:MR
First Name:ADELEKE
Middle Name:M
Last Name:ADESANYA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 KOSCIUSZKO ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6731
Mailing Address - Country:US
Mailing Address - Phone:347-489-0765
Mailing Address - Fax:
Practice Address - Street 1:520 KOSCIUSZKO ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-6731
Practice Address - Country:US
Practice Address - Phone:347-489-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402883363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health