Provider Demographics
NPI:1427489657
Name:ADELAIYE, ADEBOLA
Entity type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:
Last Name:ADELAIYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADEBOLA
Other - Middle Name:C
Other - Last Name:ADESANMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 DORRANCE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-2018
Mailing Address - Country:US
Mailing Address - Phone:401-200-8242
Mailing Address - Fax:401-782-0858
Practice Address - Street 1:10 DORRANCE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-2018
Practice Address - Country:US
Practice Address - Phone:401-200-8242
Practice Address - Fax:401-415-0418
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN45445163W00000X
RINPP37791363LF0000X
RIAPRN03296364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily