Provider Demographics
NPI:1487366639
Name:GBADEYAN, OLUWABUKOLAMI
Entity type:Individual
Prefix:
First Name:OLUWABUKOLAMI
Middle Name:
Last Name:GBADEYAN
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 1:6700 JAMES FARMER WAY
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-2158
Mailing Address - Country:US
Mailing Address - Phone:240-716-4956
Mailing Address - Fax:
Practice Address - Street 1:6700 JAMES FARMER WAY
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-2158
Practice Address - Country:US
Practice Address - Phone:240-716-4956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician