Provider Demographics
NPI:1740786516
Name:KOMOLAFE, TUNDE SUNNY
Entity Type:Individual
Prefix:
First Name:TUNDE
Middle Name:SUNNY
Last Name:KOMOLAFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7316
Mailing Address - Country:US
Mailing Address - Phone:202-415-0430
Mailing Address - Fax:301-336-5640
Practice Address - Street 1:4330 3RD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7316
Practice Address - Country:US
Practice Address - Phone:202-415-0430
Practice Address - Fax:301-336-5640
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN966631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse