Provider Demographics
NPI:1861888547
Name:KESHINRO, OLUBUKOLA
Entity type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:
Last Name:KESHINRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLUBUKOA
Other - Middle Name:
Other - Last Name:KESHINRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:22603 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3822
Mailing Address - Country:US
Mailing Address - Phone:917-854-0954
Mailing Address - Fax:
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2832
Practice Address - Country:US
Practice Address - Phone:718-206-7135
Practice Address - Fax:718-206-7169
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339020-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily