Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Omotayo Fakorode

Individual provider Licensed Practical Nurse · NPI 1902108269

Omotayo Fakorode is a Licensed Practical Nurse in Staten Island, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2010
Specialties on file
2

Practice location Address checks out

77 Fraser St
Staten Island, NY 10314-6111
Phone: (718) 664-3438
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 648044 (NY)
Licensed Practical Nurse Taxonomy 164W00000X · Licence 263598 (NY)

Record details

NPI number1902108269
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 18, 2010
Last updated in NPPESJuly 30, 2012

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