Provider Demographics
NPI:1174117642
Name:ADEKOYA, BOLANLE ADEOLA
Entity type:Individual
Prefix:
First Name:BOLANLE
Middle Name:ADEOLA
Last Name:ADEKOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BOLANLE
Other - Middle Name:ADEOLA
Other - Last Name:ADELEYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:17 STOREY AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2330
Mailing Address - Country:US
Mailing Address - Phone:631-335-4442
Mailing Address - Fax:
Practice Address - Street 1:17 STOREY AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2330
Practice Address - Country:US
Practice Address - Phone:631-335-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568997-01163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology