Provider Demographics
NPI:1457639718
Name:SALIU, OLALEKAN SAMPSON (LPN)
Entity Type:Individual
Prefix:MR
First Name:OLALEKAN
Middle Name:SAMPSON
Last Name:SALIU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 VAN DUZER ST
Mailing Address - Street 2:APT D2
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2076
Mailing Address - Country:US
Mailing Address - Phone:917-495-3565
Mailing Address - Fax:
Practice Address - Street 1:456 VAN DUZER ST
Practice Address - Street 2:APT D2
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2076
Practice Address - Country:US
Practice Address - Phone:917-495-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293405-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse