Provider Demographics
NPI:1992387542
Name:BOLAJI, FAUSAT
Entity type:Individual
Prefix:
First Name:FAUSAT
Middle Name:
Last Name:BOLAJI
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 1:6886 RIVERDALE RD APT 524
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1071
Mailing Address - Country:US
Mailing Address - Phone:240-527-3891
Mailing Address - Fax:
Practice Address - Street 1:5513 ILLINOIS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2937
Practice Address - Country:US
Practice Address - Phone:202-882-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide