Provider Demographics
NPI:1376841437
Name:ADEOTI, ABIMBOLA OLUWATOYIN
Entity Type:Individual
Prefix:MR
First Name:ABIMBOLA
Middle Name:OLUWATOYIN
Last Name:ADEOTI
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 1:3605 BASTION LN STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3890
Mailing Address - Country:US
Mailing Address - Phone:919-369-3929
Mailing Address - Fax:919-231-2026
Practice Address - Street 1:3605 BASTION LN STE 108
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3890
Practice Address - Country:US
Practice Address - Phone:919-369-3929
Practice Address - Fax:919-231-2026
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4245171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator