Provider Demographics
NPI:1134788144
Name:LASEINDE, AGNES OLUFUNKE (MD)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:OLUFUNKE
Last Name:LASEINDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:465 COLUMBUS AVENUE
Mailing Address - Street 2:3RD FLOOR SUITE 370
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-769-1600
Mailing Address - Fax:914-769-1610
Practice Address - Street 1:465 COLUMBUS AVENUE
Practice Address - Street 2:3RD FLOOR SUITE 370
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-769-1600
Practice Address - Fax:914-769-1610
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY331738207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine