Provider Demographics
NPI:1710524517
Name:OBADINA, OLUFUNKE OLUDAYO (RD, CDN)
Entity Type:Individual
Prefix:
First Name:OLUFUNKE
Middle Name:OLUDAYO
Last Name:OBADINA
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 BEACH 65TH ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1354
Mailing Address - Country:US
Mailing Address - Phone:718-415-6979
Mailing Address - Fax:
Practice Address - Street 1:519 BEACH 65TH ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1354
Practice Address - Country:US
Practice Address - Phone:718-415-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-30
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009634-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered