Provider Demographics
NPI:1366998601
Name:AZEEZ-TAIWO, SOLA
Entity type:Individual
Prefix:
First Name:SOLA
Middle Name:
Last Name:AZEEZ-TAIWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 BAY STREET
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3834
Mailing Address - Country:US
Mailing Address - Phone:718-273-0097
Mailing Address - Fax:718-273-2840
Practice Address - Street 1:498 BAY STREET
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3834
Practice Address - Country:US
Practice Address - Phone:718-273-0097
Practice Address - Fax:718-273-2840
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver