Provider Demographics
NPI:1871023085
Name:ADEYEFA, OLUYEMI ADEDAMOLA
Entity type:Individual
Prefix:
First Name:OLUYEMI
Middle Name:ADEDAMOLA
Last Name:ADEYEFA
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 1:6614 RONAD ROAD APT. 202
Mailing Address - Street 2:
Mailing Address - City:CAPTIOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6614 RONALD RD APT 202
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-7405
Practice Address - Country:US
Practice Address - Phone:240-408-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12788374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA12788Medicaid