Provider Demographics
NPI:1073008330
Name:GBADEYANKA, HABIB D
Entity Type:Individual
Prefix:
First Name:HABIB
Middle Name:D
Last Name:GBADEYANKA
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 1:8755 CONTEE RD APT 201
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1925
Mailing Address - Country:US
Mailing Address - Phone:240-845-4363
Mailing Address - Fax:
Practice Address - Street 1:8755 CONTEE RD APT 201
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1925
Practice Address - Country:US
Practice Address - Phone:240-845-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHHA13772374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide