Provider Demographics
NPI:1356400675
Name:ADEKUNLE, ADERONKE SHOLAKUNMI (AA, BS)
Entity type:Individual
Prefix:
First Name:ADERONKE
Middle Name:SHOLAKUNMI
Last Name:ADEKUNLE
Suffix:
Gender:F
Credentials:AA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20106 NW 51ST CT
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4650
Mailing Address - Country:US
Mailing Address - Phone:786-262-9660
Mailing Address - Fax:
Practice Address - Street 1:20106 NW 51ST CT
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33055-4650
Practice Address - Country:US
Practice Address - Phone:786-262-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6914900171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator