Provider Demographics
NPI:1538666300
Name:MODUPE, OLUWATOYIN ADEKITAN (FNP)
Entity Type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:ADEKITAN
Last Name:MODUPE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CINDER ROAD
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980
Mailing Address - Country:US
Mailing Address - Phone:917-443-3617
Mailing Address - Fax:914-365-5270
Practice Address - Street 1:16 GUION PLACE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-365-4059
Practice Address - Fax:914-365-5270
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341699-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine