Provider Demographics
NPI:1407565989
Name:AFRIYIE, SHADRACK OPOKU
Entity Type:Individual
Prefix:
First Name:SHADRACK
Middle Name:OPOKU
Last Name:AFRIYIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINDING WOOD DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2069
Mailing Address - Country:US
Mailing Address - Phone:347-208-2576
Mailing Address - Fax:
Practice Address - Street 1:100 WINDING WOOD DR APT 3A
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-2069
Practice Address - Country:US
Practice Address - Phone:347-208-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJW30-RMV347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle