Provider Demographics
NPI:1720805559
Name:GBADAMOSI, AFEEZ BABATUNDE
Entity type:Individual
Prefix:
First Name:AFEEZ
Middle Name:BABATUNDE
Last Name:GBADAMOSI
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 1:6506 BAREBACK TER
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4197
Mailing Address - Country:US
Mailing Address - Phone:804-490-3713
Mailing Address - Fax:
Practice Address - Street 1:6506 BAREBACK TER
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4197
Practice Address - Country:US
Practice Address - Phone:804-490-3713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002104892164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse