MEDICARE: ADETUTU LATEEFAT SONEYE 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NRJ14984600	NJ
2	363L00000X	Nurse Practitioner	26NRJ14984600	NJ

General Provider Information

NPI Number	:	1487013629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADETUTU LATEEFAT SONEYE NP

Provider Business Mailing Address
First Line	:	243 HARDING BLVD
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-2912
Country	:	US
Telephone Number	:	516-234-1183
Fax Number	:	855-915-5040

Provider Business Practice Location Address
First Line	:	118 DIXON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-2804
Country	:	US
Telephone Number	:	516-234-1183
Fax Number	:

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

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/05/2026

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