Provider Demographics
NPI:1083932321
Name:ADEYANJU, ADETUNJI SAMUEL
Entity Type:Individual
Prefix:MR
First Name:ADETUNJI
Middle Name:SAMUEL
Last Name:ADEYANJU
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 1:2788 PLAZA DR APT D
Mailing Address - Street 2:TOWNSHIP LINE, CARLTON APARTMENTS
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4340
Mailing Address - Country:US
Mailing Address - Phone:317-937-9676
Mailing Address - Fax:
Practice Address - Street 1:6350 WESTHAVEN DR STE F
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2731
Practice Address - Country:US
Practice Address - Phone:317-291-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program