Provider Demographics
NPI:1447803648
Name:ABIODUN, VICTORIA FUNMI
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:FUNMI
Last Name:ABIODUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 E 220TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5312
Mailing Address - Country:US
Mailing Address - Phone:718-790-7563
Mailing Address - Fax:
Practice Address - Street 1:824 E 220TH ST APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5312
Practice Address - Country:US
Practice Address - Phone:718-790-7563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY768809163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse