Individual
AGATHA SOWAME ODETOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2811 QUEENS PLZ N, LONG ISLAND CITY, NY 11101-4172
(718) 391-8300
Mailing address
20 W MOSHOLU PKWY S APT 10A, BRONX, NY 10468-1127
(347) 244-3407
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
805420
NY
Other
Enumeration date
10/15/2021
Last updated
10/15/2021
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