Provider Demographics
NPI:1427772771
Name:AJAYI, MODUPE MUYIBATU I
Entity type:Individual
Prefix:MRS
First Name:MODUPE
Middle Name:MUYIBATU
Last Name:AJAYI
Suffix:I
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MODUPE
Other - Middle Name:MUYIBATU
Other - Last Name:YUSUF
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5939 VEGAS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2422
Mailing Address - Country:US
Mailing Address - Phone:702-241-8755
Mailing Address - Fax:
Practice Address - Street 1:5939 VEGAS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2422
Practice Address - Country:US
Practice Address - Phone:702-241-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide