MEDICARE: MR. AKINTOLA M SHENBANJO II CNA / ALF ADMIN.

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	376K00000X	Nurse's Aide	304246	FL

General Provider Information

NPI Number	:	1265072110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AKINTOLA M SHENBANJO II CNA / ALF ADMIN.

Provider Business Mailing Address
First Line	:	6710 COLLINS RD APT 115
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5872
Country	:	US
Telephone Number	:	904-470-9839
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 COLLINS RD APT 115
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5872
Country	:	US
Telephone Number	:	904-470-9839
Fax Number	:

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

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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