Individual
OMOLAYO TAIBAT SUARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(718) 514-3212
Mailing address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(718) 514-3212
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
465074
NY
Other
Enumeration date
11/17/2016
Last updated
11/17/2016
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