Healthcare Provider Details

I. General information

NPI: 1205626157
Provider Name (Legal Business Name): OLUWADARA ADESUWA TOKUNBOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

515 W 59TH ST APT 29K
NEW YORK NY
10019-1031
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4000
  • Fax:
Mailing address:
  • Phone: 980-875-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: