Healthcare Provider Details

I. General information

NPI: 1881352789
Provider Name (Legal Business Name): FOLUKE ADESOLA AKINOLA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 FAIRMONT AVE
MEDFORD NY
11763-3002
US

IV. Provider business mailing address

16 FAIRMONT AVE
MEDFORD NY
11763-3002
US

V. Phone/Fax

Practice location:
  • Phone: 718-930-9594
  • Fax:
Mailing address:
  • Phone: 718-930-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403889
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number554527
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberF403889-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: