Provider Demographics
NPI:1194091785
Name:ADEOSUN, SHERRI A
Entity type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:A
Last Name:ADEOSUN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AYOBAMI
Other - Middle Name:
Other - Last Name:BALOGUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:488 BEACH 66TH STR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11692
Mailing Address - Country:US
Mailing Address - Phone:718-634-7914
Mailing Address - Fax:
Practice Address - Street 1:488 BEACH 66TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11692-1430
Practice Address - Country:US
Practice Address - Phone:718-634-7914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY557598163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse