Provider Demographics
NPI:1851759302
Name:ADEKUNLE-MOSES, EGBE BENEDICTA I
Entity Type:Individual
Prefix:MRS
First Name:EGBE
Middle Name:BENEDICTA
Last Name:ADEKUNLE-MOSES
Suffix:I
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 1:229 HEBRON ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-6201
Mailing Address - Country:US
Mailing Address - Phone:857-544-9755
Mailing Address - Fax:
Practice Address - Street 1:229 HEBRON ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-6201
Practice Address - Country:US
Practice Address - Phone:857-544-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN90968164W00000X
MA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide