Provider Demographics
NPI:1518412717
Name:ABIODUN, OLUBUNMI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:ABIODUN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1625
Mailing Address - Country:US
Mailing Address - Phone:718-809-7018
Mailing Address - Fax:
Practice Address - Street 1:38 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1625
Practice Address - Country:US
Practice Address - Phone:718-809-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340987-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily