Provider Demographics
NPI:1972310779
Name:ADESANMI, ADELEYE VICTOR (CEO)
Entity type:Individual
Prefix:
First Name:ADELEYE
Middle Name:VICTOR
Last Name:ADESANMI
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SABLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2931
Mailing Address - Country:US
Mailing Address - Phone:317-371-0837
Mailing Address - Fax:
Practice Address - Street 1:6901 SABLE POINT DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2931
Practice Address - Country:US
Practice Address - Phone:317-371-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant