Provider Demographics
NPI:1174800353
Name:DADA, OPEYEMI KEMIKI
Entity type:Individual
Prefix:MS
First Name:OPEYEMI
Middle Name:KEMIKI
Last Name:DADA
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 1:770 IDLEWYLD DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-7838
Mailing Address - Country:US
Mailing Address - Phone:240-505-2416
Mailing Address - Fax:
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:NEMOURS DUPONT PEDIATRICS
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-5500
Practice Address - Fax:302-651-5510
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELJ0000301363L00000X, 363LP0200X
IL209009246363LP0200X
MDR182034363LP0200X
DEL8-0010526363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics