Provider Demographics
NPI:1093153470
Name:BELLO, SULAIMON ADISA
Entity Type:Individual
Prefix:MR
First Name:SULAIMON
Middle Name:ADISA
Last Name:BELLO
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 1:4504 CIMMARON GREENFIELDS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6341
Mailing Address - Country:US
Mailing Address - Phone:202-497-9171
Mailing Address - Fax:
Practice Address - Street 1:4504 CIMMARON GREENFIELDS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6341
Practice Address - Country:US
Practice Address - Phone:202-497-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$OtherHHA