Provider Demographics
NPI:1225522469
Name:SOTADE, ADETAYO EMMANUEL
Entity Type:Individual
Prefix:
First Name:ADETAYO
Middle Name:EMMANUEL
Last Name:SOTADE
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 1:14801 E 18TH PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-4480
Mailing Address - Country:US
Mailing Address - Phone:720-427-4935
Mailing Address - Fax:
Practice Address - Street 1:2121 FAIRPLAY ST APT B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-4652
Practice Address - Country:US
Practice Address - Phone:720-427-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty