MEDICARE: SARAH ADEWALE LPN

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	164W00000X	Licensed Practical Nurse	306286-1	NY

General Provider Information

NPI Number	:	1386917052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ADEWALE LPN

Provider Business Mailing Address
First Line	:	1742 RICHMOND RD
Second Line	:	APT 3D
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2567
Country	:	US
Telephone Number	:	347-244-5907
Fax Number	:

Provider Business Practice Location Address
First Line	:	1742 RICHMOND RD
Second Line	:	APT 3D
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2567
Country	:	US
Telephone Number	:	347-244-5907
Fax Number	:

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

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	02/10/2012

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