Provider Demographics
NPI:1265072110
Name:SHENBANJO, AKINTOLA M II (CNA / ALF ADMIN)
Entity type:Individual
Prefix:MR
First Name:AKINTOLA
Middle Name:M
Last Name:SHENBANJO
Suffix:II
Gender:M
Credentials:CNA / ALF ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 COLLINS RD APT 115
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5872
Mailing Address - Country:US
Mailing Address - Phone:904-470-9839
Mailing Address - Fax:
Practice Address - Street 1:6710 COLLINS RD APT 115
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5872
Practice Address - Country:US
Practice Address - Phone:904-470-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL304246376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty