MEDICARE: TINUKE AFOLABI 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	319390-1	NY

General Provider Information

NPI Number	:	1417345588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINUKE AFOLABI LPN

Provider Business Mailing Address
First Line	:	36 SUNSET AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5039
Country	:	US
Telephone Number	:	908-342-5917
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 SUNSET AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5039
Country	:	US
Telephone Number	:	908-342-5917
Fax Number	:

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

Provider Enumeration Date	:	12/24/2014
Last Update Date	:	12/24/2014

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