Provider Demographics
NPI:1316208770
Name:OLUDASI, ADEBOLA ADEWALE (HHA)
Entity Type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:ADEWALE
Last Name:OLUDASI
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 75TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1922
Mailing Address - Country:US
Mailing Address - Phone:301-257-4275
Mailing Address - Fax:
Practice Address - Street 1:3217 75TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-1922
Practice Address - Country:US
Practice Address - Phone:301-257-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCLPN1007593164W00000X
MDLP50856164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide