Provider Demographics
NPI:1053787374
Name:OLAWOYIN, SAMUEL O (RN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:O
Last Name:OLAWOYIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:SAMUEL
Other - Middle Name:O
Other - Last Name:OLAWOYIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2029 SEAGIRT BLVD APT 2D
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2921
Mailing Address - Country:US
Mailing Address - Phone:347-965-8968
Mailing Address - Fax:
Practice Address - Street 1:2029 SEAGIRT BLVD APT 2D
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2921
Practice Address - Country:US
Practice Address - Phone:347-965-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690943163WH0200X
NYF348582-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health