Provider Demographics
NPI:1467227405
Name:DAVID, OLUWAMUTIWA AKINADE
Entity Type:Individual
Prefix:
First Name:OLUWAMUTIWA
Middle Name:AKINADE
Last Name:DAVID
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 1:21 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1624
Mailing Address - Country:US
Mailing Address - Phone:718-316-1736
Mailing Address - Fax:718-978-0032
Practice Address - Street 1:21 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1624
Practice Address - Country:US
Practice Address - Phone:718-316-1736
Practice Address - Fax:718-978-0032
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337679164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse