Provider Demographics
NPI:1285164871
Name:AYODELE, ABAYOMI T
Entity type:Individual
Prefix:
First Name:ABAYOMI
Middle Name:T
Last Name:AYODELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 RIVERDALE RD APT 103
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3904
Mailing Address - Country:US
Mailing Address - Phone:347-885-4984
Mailing Address - Fax:
Practice Address - Street 1:7737 RIVERDALE ROAD
Practice Address - Street 2:APT 103
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:347-885-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12673374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA340029784706Medicaid