Provider Demographics
NPI:1699431452
Name:ADEKOYA, ADEFOLAHAN M
Entity type:Individual
Prefix:
First Name:ADEFOLAHAN
Middle Name:M
Last Name:ADEKOYA
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 1:45 PAERDEGAT 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4133
Mailing Address - Country:US
Mailing Address - Phone:347-579-9076
Mailing Address - Fax:
Practice Address - Street 1:45 PAERDEGAT 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4133
Practice Address - Country:US
Practice Address - Phone:347-579-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY813197-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse