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General NPI Number Information
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NPI Number | 1821947516
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Entity Type | Organization
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Legal Business Name | SOULBRIDGE HEALTH INC
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 418 BROADWAY # 10795
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 410-900-8897
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Fax | 410-888-7145
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Provider Business Mailing Address
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Address Line | 418 BROADWAY # 10795
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 410-900-8897
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Fax | 410-888-7145
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. FOLASHADE KANIMODO
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Credential | NURSE PRACTITIONER
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Telephone | 410-900-8897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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