Provider Demographics
NPI:1962822155
Name:AKINADE, IFELOLUWA ALICE
Entity Type:Individual
Prefix:
First Name:IFELOLUWA
Middle Name:ALICE
Last Name:AKINADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IFELOLUWA
Other - Middle Name:ALICE ADESOLA
Other - Last Name:AKINADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CM, LM
Mailing Address - Street 1:6200 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1409
Mailing Address - Country:US
Mailing Address - Phone:718-945-7150
Mailing Address - Fax:718-663-6160
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2054
Practice Address - Country:US
Practice Address - Phone:718-245-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-26
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001613367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife