Provider Demographics
NPI:1316634314
Name:ADEBAYO, MOJISOLA ANIKE (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:MOJISOLA
Middle Name:ANIKE
Last Name:ADEBAYO
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2646
Mailing Address - Country:US
Mailing Address - Phone:301-793-8838
Mailing Address - Fax:
Practice Address - Street 1:6516 100TH AVE
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2646
Practice Address - Country:US
Practice Address - Phone:301-793-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184893363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health