Provider Demographics
NPI:1114694858
Name:ADELAJA, ADELAGUN OLUWASESAN (NP)
Entity Type:Individual
Prefix:
First Name:ADELAGUN
Middle Name:OLUWASESAN
Last Name:ADELAJA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6259 DE COSTA AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1335
Mailing Address - Country:US
Mailing Address - Phone:347-824-8447
Mailing Address - Fax:
Practice Address - Street 1:6259 DE COSTA AVE FL 1
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1335
Practice Address - Country:US
Practice Address - Phone:347-824-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403404363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health