Provider Demographics
NPI:1104363167
Name:ADESANYA, YETUNDE
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:
Last Name:ADESANYA
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 1:6815 RIVERDALE RD
Mailing Address - Street 2:APT D4
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1804
Mailing Address - Country:US
Mailing Address - Phone:301-364-8778
Mailing Address - Fax:
Practice Address - Street 1:6815 RIVERDALE RD
Practice Address - Street 2:APT D4
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1804
Practice Address - Country:US
Practice Address - Phone:301-364-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12477374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide