MEDICARE: IYABO AINA ONIFADE NP

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	363LP2300X	Primary Care Nurse Practitioner	F308163	NY

General Provider Information

NPI Number	:	1386172112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IYABO AINA ONIFADE NP

Provider Business Mailing Address
First Line	:	89 ANDROS AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-2048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 E 99TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6808
Country	:	US
Telephone Number	:	877-226-8500
Fax Number	:

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

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	05/24/2017

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