Basic Information
| Provider Information | |||||||||
| NPI: | 1962822155 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AKINADE | ||||||||
| FirstName: | IFELOLUWA | ||||||||
| MiddleName: | ALICE | ||||||||
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| OtherLastName: | AKINADE | ||||||||
| OtherFirstName: | IFELOLUWA | ||||||||
| OtherMiddleName: | ALICE ADESOLA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | CM, LM | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6200 BEACH CHANNEL DR | ||||||||
| Address2: | |||||||||
| City: | ARVERNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116921409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189457150 | ||||||||
| FaxNumber: | 7186636160 | ||||||||
| Practice Location | |||||||||
| Address1: | 451 CLARKSON AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182453131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2014 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 001613 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.