MEDICARE: SAMUEL OYEWOLE ADEYEYE R.D.

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	133NN1002X	Nutrition Education Nutritionist	005445	NY

General Provider Information

NPI Number	:	1720116544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL OYEWOLE ADEYEYE R.D.

Provider Business Mailing Address
First Line	:	1587 STRAWBERRY RD
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1046
Country	:	US
Telephone Number	:	914-526-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 WILSON AVENUE
Second Line	:	COMPREHENSIVE HEALTH CARE AND REHABILITATION SERVICES
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3149
Country	:	US
Telephone Number	:	718-455-5500
Fax Number	:	718-455-8700

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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