Provider Demographics
NPI:1578136164
Name:SHOTOMIWA, SADIQ TEMITOPE (BSN)
Entity Type:Individual
Prefix:
First Name:SADIQ
Middle Name:TEMITOPE
Last Name:SHOTOMIWA
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 MATTHEWS AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2078
Mailing Address - Country:US
Mailing Address - Phone:786-873-2220
Mailing Address - Fax:
Practice Address - Street 1:2160 MATTHEWS AVE APT 6C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2078
Practice Address - Country:US
Practice Address - Phone:786-873-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY798148-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse