Provider Demographics
NPI:1578897617
Name:SALAU, ADEOLA
Entity Type:Individual
Prefix:
First Name:ADEOLA
Middle Name:
Last Name:SALAU
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 1:77 CLINTON ST
Mailing Address - Street 2:G4
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-1545
Mailing Address - Country:US
Mailing Address - Phone:315-601-6000
Mailing Address - Fax:
Practice Address - Street 1:77 CLINTON ST
Practice Address - Street 2:G4
Practice Address - City:NEW YORK MILLS
Practice Address - State:NY
Practice Address - Zip Code:13417-1545
Practice Address - Country:US
Practice Address - Phone:315-601-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY609646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse