MEDICARE: SEUN RODEMADE-TANIMOWO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	765672	NY
2	164W00000X	Licensed Practical Nurse	310597	NY

General Provider Information

NPI Number	:	1154679082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEUN RODEMADE-TANIMOWO RN

Provider Business Mailing Address
First Line	:	15134 133RD AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11434-3502
Country	:	US
Telephone Number	:	718-671-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	15134 133RD AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11434-3502
Country	:	US
Telephone Number	:	917-498-9657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	01/12/2026

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