Healthcare Provider Details

I. General information

NPI: 1306107263
Provider Name (Legal Business Name): OLUBUNMI SONUBI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 140TH ST 3B
NEW YORK NY
10030-1791
US

IV. Provider business mailing address

205 WEST 140TH STREET, 3B
NEWYORK NY
10030
US

V. Phone/Fax

Practice location:
  • Phone: 917-806-6710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number501959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: