Provider Demographics
NPI:1093448946
Name:ADEBAMBO, MOFIFOLUWA ADESEKE
Entity Type:Individual
Prefix:
First Name:MOFIFOLUWA
Middle Name:ADESEKE
Last Name:ADEBAMBO
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 1:10343 TAILCOAT WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3810
Mailing Address - Country:US
Mailing Address - Phone:301-756-6050
Mailing Address - Fax:
Practice Address - Street 1:10343 TAILCOAT WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3810
Practice Address - Country:US
Practice Address - Phone:301-756-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide