Provider Demographics
NPI:1518397702
Name:ADESANYA, ABIOLA
Entity Type:Individual
Prefix:
First Name:ABIOLA
Middle Name:
Last Name:ADESANYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 KOSCIUSZKO ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2308
Mailing Address - Country:US
Mailing Address - Phone:347-635-3621
Mailing Address - Fax:
Practice Address - Street 1:520 KOSCIUSZKO ST
Practice Address - Street 2:APT. 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2308
Practice Address - Country:US
Practice Address - Phone:347-635-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314452164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse