Individual
ADESHOLA DIRISU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
104 PINEBROOK PL, BAY SHORE, NY 11706-4457
(631) 647-3757
Mailing address
104 PINEBROOK PL, BAY SHORE, NY 11706-4457
(631) 647-3757
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
290354
NY
Other
Enumeration date
06/02/2010
Last updated
06/02/2010
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