Individual
DACCU BAMIDELE SONUBIISHAQ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
99 LENOX AVE FL 1, EAST ORANGE, NJ 07018-3102
(309) 966-5184
Mailing address
99 LENOX AVE FL 1, EAST ORANGE, NJ 07018-3102
(309) 966-5184
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
953594-01
NY
164W00000X
Licensed Practical Nurse
97121
TN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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Other
Enumeration date
10/03/2022
Last updated
08/13/2025
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