Provider Demographics
NPI:1306107263
Name:SONUBI, OLUBUNMI
Entity type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:SONUBI
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 1:205 WEST 140TH STREET,
Mailing Address - Street 2:3B
Mailing Address - City:NEWYORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 W 140TH ST
Practice Address - Street 2:3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1791
Practice Address - Country:US
Practice Address - Phone:917-806-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY501959163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator