Provider Demographics
NPI:1164741260
Name:FISAYO, ADENIYI (MD)
Entity Type:Individual
Prefix:
First Name:ADENIYI
Middle Name:
Last Name:FISAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208018
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8018
Mailing Address - Country:US
Mailing Address - Phone:203-785-5602
Mailing Address - Fax:203-737-6375
Practice Address - Street 1:6 DEVINE ST, SUITE 2B
Practice Address - Street 2:YALE NEUROLOGY
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-785-5602
Practice Address - Fax:203-737-6375
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0714952084N0400X
PAMD4503172084N0400X
CT539292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology