Adeshola Dirisu, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

290354 Issued in NY

Practice address

104 Pinebrook PL
Bay Shore, NY 11706-4457

Phone

(631) 647-3757

NPI assigned

Jun 2, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275436800000",
    "number": "1164742011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 PINEBROOK PL",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117064457",
            "telephone_number": "631-647-3757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 PINEBROOK PL",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117064457",
            "telephone_number": "631-647-3757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIRISU",
        "first_name": "ADESHOLA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-02",
        "last_updated": "2010-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "290354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Dicosimo
• Michael Diforti, LMHC
• Donna Digregorio, PA
• Nicholas Dilena
• Florence Ann Dimartino, NP
• Discover Podiatry, P.C.
• Christina Marie Divittorio, RN
• DLJ Spectacles
• Jaclynn DO, MD
• Jannika Dodge Khatami, M.D.

• Licensed Practical Nurse in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.