Provider Demographics
NPI:1508000779
Name:AGHEDO, OSARO
Entity Type:Individual
Prefix:
First Name:OSARO
Middle Name:
Last Name:AGHEDO
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 1:765 LINCOLN AVENUE
Mailing Address - Street 2:APT# 6-E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1446
Mailing Address - Country:US
Mailing Address - Phone:646-290-7564
Mailing Address - Fax:
Practice Address - Street 1:97 EUCLID AVE
Practice Address - Street 2:APT# 3-L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1446
Practice Address - Country:US
Practice Address - Phone:646-290-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse