MEDICARE: AZIZAH ODESESAN

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	163WH0200X	Home Health Registered Nurse	805255	NY

General Provider Information

NPI Number	:	1265268148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZIZAH ODESESAN

Provider Business Mailing Address
First Line	:	13119 233RD ST
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-1305
Country	:	US
Telephone Number	:	516-713-7065
Fax Number	:

Provider Business Practice Location Address
First Line	:	13119 233RD ST
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-1305
Country	:	US
Telephone Number	:	516-713-7065
Fax Number	:

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

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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Directions to “ AZIZAH ODESESAN ” Practice Location

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