Healthcare Provider Details

I. General information

NPI: 1609299239
Provider Name (Legal Business Name): OLUWATOSIN SHOKEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121A WEST 20TH STREET VILLAGE DIAGNOSTIC & TREATMENT CENTER
NEW YORK NY
10011
US

IV. Provider business mailing address

109 PARK HILL AVE
YONKERS NY
10701-4822
US

V. Phone/Fax

Practice location:
  • Phone: 212-337-9290
  • Fax: 212-337-9275
Mailing address:
  • Phone: 347-280-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337894
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: