MEDICARE: MRS. SHERIFAT ISHOLA ANIKULAPO L.P.N

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	296364-1	NY

General Provider Information

NPI Number	:	1447579289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERIFAT ISHOLA ANIKULAPO L.P.N

Provider Business Mailing Address
First Line	:	80 N BURGHER AVE
Second Line	:	1B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1457
Country	:	US
Telephone Number	:	718-981-5106
Fax Number	:	718-981-5106

Provider Business Practice Location Address
First Line	:	80 N BURGHER AVE
Second Line	:	1B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1457
Country	:	US
Telephone Number	:	718-981-5106
Fax Number	:	718-981-5106

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

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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