Provider Demographics
NPI:1588991210
Name:AKINKUNMI, ABIDEMI S (NP)
Entity type:Individual
Prefix:MS
First Name:ABIDEMI
Middle Name:S
Last Name:AKINKUNMI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ABIDEMI
Other - Middle Name:
Other - Last Name:DISU-SAHEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:973 E 221ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1015
Mailing Address - Country:US
Mailing Address - Phone:347-425-3971
Mailing Address - Fax:
Practice Address - Street 1:3000 MARCUS AVE STE 2W15
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1005
Practice Address - Country:US
Practice Address - Phone:855-201-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY623825163W00000X
NY340118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04437490Medicaid