Provider Demographics
NPI:1942183264
Name:FADEYIBI, SIMILEOLUWA E
Entity type:Individual
Prefix:
First Name:SIMILEOLUWA
Middle Name:E
Last Name:FADEYIBI
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 1:300 HERB HILL RD APT 210
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-4410
Mailing Address - Country:US
Mailing Address - Phone:346-715-8104
Mailing Address - Fax:
Practice Address - Street 1:300 HERB HILL RD APT 210
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-4410
Practice Address - Country:US
Practice Address - Phone:346-715-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst