Provider Demographics
NPI:1659931582
Name:OLADELE, ABOSEDE
Entity Type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:
Last Name:OLADELE
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 1:15532 114TH RD FL 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1004
Mailing Address - Country:US
Mailing Address - Phone:646-359-9875
Mailing Address - Fax:
Practice Address - Street 1:15532 114TH RD FL 1
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1004
Practice Address - Country:US
Practice Address - Phone:646-359-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332679164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse