Provider Demographics
NPI:1528595592
Name:BATAMA, TAYO SIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:TAYO
Middle Name:SIA
Last Name:BATAMA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1929
Mailing Address - Country:US
Mailing Address - Phone:917-651-3877
Mailing Address - Fax:
Practice Address - Street 1:264 GORDON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1929
Practice Address - Country:US
Practice Address - Phone:917-651-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310790164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse