Provider Demographics
NPI:1508677089
Name:FAKINLEDE, FOLUKEMI BOSEDE
Entity type:Individual
Prefix:MRS
First Name:FOLUKEMI
Middle Name:BOSEDE
Last Name:FAKINLEDE
Suffix:
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 1:1104 FIR CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1843
Mailing Address - Country:US
Mailing Address - Phone:732-589-8733
Mailing Address - Fax:
Practice Address - Street 1:1104 FIR CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1843
Practice Address - Country:US
Practice Address - Phone:732-589-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15237400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health