Provider Demographics
NPI:1225508682
Name:EKUNDAYO, ADEDAYO ADEKEMISOLA (PHD CRNP CCRN)
Entity Type:Individual
Prefix:DR
First Name:ADEDAYO
Middle Name:ADEKEMISOLA
Last Name:EKUNDAYO
Suffix:
Gender:F
Credentials:PHD CRNP CCRN
Other - Prefix:DR
Other - First Name:ADEDAYO
Other - Middle Name:ADEKEMISOLA
Other - Last Name:EKUNDAYO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:7309 BALTIMORE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3200
Mailing Address - Country:US
Mailing Address - Phone:301-892-6296
Mailing Address - Fax:
Practice Address - Street 1:7309 BALTIMORE AVE STE 220
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3200
Practice Address - Country:US
Practice Address - Phone:301-892-6296
Practice Address - Fax:301-746-0551
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1014953363L00000X
MDR091648363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner