Provider Demographics
NPI:1750611240
Name:BASHUA, TAIWO
Entity type:Individual
Prefix:
First Name:TAIWO
Middle Name:
Last Name:BASHUA
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 1:636 JEFFERSON PL
Mailing Address - Street 2:APT #1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2594
Mailing Address - Country:US
Mailing Address - Phone:718-589-3440
Mailing Address - Fax:
Practice Address - Street 1:636 JEFFERSON PL
Practice Address - Street 2:APT #1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2594
Practice Address - Country:US
Practice Address - Phone:718-589-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285017-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse