Provider Demographics
NPI:1508565565
Name:CLAUDE-ADEWUNMI, LARISSA STEPHANIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:STEPHANIE
Last Name:CLAUDE-ADEWUNMI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:STEPHANIE
Other - Last Name:CLAUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 COUNTY CENTER RD APT C-12
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1523
Mailing Address - Country:US
Mailing Address - Phone:516-724-2194
Mailing Address - Fax:
Practice Address - Street 1:1250 WATERS PL STE 1206
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2735
Practice Address - Country:US
Practice Address - Phone:718-409-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029854363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant