Provider Demographics
NPI:1861696049
Name:ADASONLA, AYODELE O
Entity type:Individual
Prefix:
First Name:AYODELE
Middle Name:O
Last Name:ADASONLA
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 1:30 KIMBERLY LN
Mailing Address - Street 2:APT# 16A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3654
Mailing Address - Country:US
Mailing Address - Phone:718-727-1170
Mailing Address - Fax:
Practice Address - Street 1:30 KIMBERLY LN
Practice Address - Street 2:APT# 16A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3654
Practice Address - Country:US
Practice Address - Phone:718-727-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN275456164W00000X
NY278073-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse