Provider Demographics
NPI:1023344108
Name:SOBAMOWO, KEHINDE TINUOLA (RN)
Entity type:Individual
Prefix:
First Name:KEHINDE
Middle Name:TINUOLA
Last Name:SOBAMOWO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N ELLIOTT PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1043
Mailing Address - Country:US
Mailing Address - Phone:212-719-9600
Mailing Address - Fax:
Practice Address - Street 1:3373 FENTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2818
Practice Address - Country:US
Practice Address - Phone:212-719-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY598224163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management