Provider Demographics
NPI:1083960298
Name:OLOBATUYI, AYODEJI
Entity Type:Individual
Prefix:
First Name:AYODEJI
Middle Name:
Last Name:OLOBATUYI
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 1:4308 CONCEPT CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1900
Mailing Address - Country:US
Mailing Address - Phone:202-544-8211
Mailing Address - Fax:202-544-8216
Practice Address - Street 1:313 8TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6107
Practice Address - Country:US
Practice Address - Phone:202-544-8211
Practice Address - Fax:202-544-8216
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide