Provider Demographics
NPI:1154833986
Name:ADEDEJI, ABIOLA
Entity Type:Individual
Prefix:
First Name:ABIOLA
Middle Name:
Last Name:ADEDEJI
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 1:52 BENJAMIN PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1659
Mailing Address - Country:US
Mailing Address - Phone:347-283-8524
Mailing Address - Fax:
Practice Address - Street 1:52 BENJAMIN PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1659
Practice Address - Country:US
Practice Address - Phone:347-283-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329944-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY625248236OtherDRIVEN LICENSE