Healthcare Provider Details

I. General information

NPI: 1922927425
Provider Name (Legal Business Name): KUBRAT FADAHUNSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CONCOURSE VLG W
BRONX NY
10451-3804
US

IV. Provider business mailing address

790 CONCOURSE VLG W
BRONX NY
10451-3804
US

V. Phone/Fax

Practice location:
  • Phone: 914-434-2493
  • Fax:
Mailing address:
  • Phone: 914-434-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1855601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: