Provider Demographics
NPI:1114613809
Name:ADEKOYA, ADEBOLA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:
Last Name:ADEKOYA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18502 SWEET AUTUMN DR APT 101
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5353
Mailing Address - Country:US
Mailing Address - Phone:312-590-6969
Mailing Address - Fax:
Practice Address - Street 1:7220 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7414
Practice Address - Country:US
Practice Address - Phone:312-590-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR259579363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health