Provider Demographics
NPI:1265860860
Name:ILUYOMADE, OLUWASEUN
Entity Type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:
Last Name:ILUYOMADE
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 1:3557 55TH AVE
Mailing Address - Street 2:APT 10
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1043
Mailing Address - Country:US
Mailing Address - Phone:240-389-7315
Mailing Address - Fax:
Practice Address - Street 1:3557 55TH AVE
Practice Address - Street 2:APT 10
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1043
Practice Address - Country:US
Practice Address - Phone:240-389-7315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9449374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide