Provider Demographics
NPI:1215606413
Name:ADEFUYE, ABOLAJI JOHN
Entity Type:Individual
Prefix:MR
First Name:ABOLAJI
Middle Name:JOHN
Last Name:ADEFUYE
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 1:6505 LANDOVER RD APT T3
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1417
Mailing Address - Country:US
Mailing Address - Phone:301-257-4788
Mailing Address - Fax:
Practice Address - Street 1:6505 LANDOVER RD APT T3
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1417
Practice Address - Country:US
Practice Address - Phone:301-257-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200001263374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide