Provider Demographics
NPI:1811473838
Name:FAWOLE, RASHEEDAT YETUNDE (MD)
Entity type:Individual
Prefix:
First Name:RASHEEDAT YETUNDE
Middle Name:
Last Name:FAWOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 GRAND CONCOURSE APT 13G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-8219
Mailing Address - Country:US
Mailing Address - Phone:979-255-7508
Mailing Address - Fax:
Practice Address - Street 1:BRONX- LEBANON HOSPITAL CENTER
Practice Address - Street 2:1650 GRAND CONCOURSE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program