Provider Demographics
NPI:1700216454
Name:AGUNLOYE, CHRISTIANAH
Entity Type:Individual
Prefix:
First Name:CHRISTIANAH
Middle Name:
Last Name:AGUNLOYE
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 1:26 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1318
Mailing Address - Country:US
Mailing Address - Phone:631-617-9971
Mailing Address - Fax:
Practice Address - Street 1:26 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1318
Practice Address - Country:US
Practice Address - Phone:631-617-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338206-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily