Provider Demographics
NPI:1740747971
Name:AJISEGBEDE, FOLASADE (CRNA)
Entity Type:Individual
Prefix:
First Name:FOLASADE
Middle Name:
Last Name:AJISEGBEDE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:FOLASADE
Other - Middle Name:
Other - Last Name:AJIBADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8704 FARRAGUT RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 WEST 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3917
Practice Address - Country:US
Practice Address - Phone:917-754-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679155163WC0200X
NY133994367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty