Provider Demographics
NPI:1063757193
Name:AYODEJI, FOLUSHO O
Entity type:Individual
Prefix:
First Name:FOLUSHO
Middle Name:O
Last Name:AYODEJI
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 1:3963 WARNER AVE
Mailing Address - Street 2:APARTMENT B3
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2044
Mailing Address - Country:US
Mailing Address - Phone:301-602-5464
Mailing Address - Fax:
Practice Address - Street 1:3963 WARNER AVE
Practice Address - Street 2:APARTMENT B3
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-2044
Practice Address - Country:US
Practice Address - Phone:301-602-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide