Provider Demographics
NPI:1285090498
Name:SOTANNDE, OLUFUNKE
Entity type:Individual
Prefix:
First Name:OLUFUNKE
Middle Name:
Last Name:SOTANNDE
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 1:317 LEHRER AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3028
Mailing Address - Country:US
Mailing Address - Phone:516-451-1170
Mailing Address - Fax:
Practice Address - Street 1:317 LEHRER AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3028
Practice Address - Country:US
Practice Address - Phone:516-451-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554535163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse