Healthcare Provider Details

I. General information

NPI: 1225332158
Provider Name (Legal Business Name): FUNMILOLA ADENIKE AKERELE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MERIDIAN BLVD
ARVERNE NY
11692-2021
US

IV. Provider business mailing address

133 MERIDIAN BLVD FL 1
ARVERNE NY
11692-2021
US

V. Phone/Fax

Practice location:
  • Phone: 347-393-5684
  • Fax:
Mailing address:
  • Phone: 347-393-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357223
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number303999
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number728734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: