Provider Demographics
NPI:1467536235
Name:ADEDEJI, OLUSOLA (MS, RD, LD, LN)
Entity Type:Individual
Prefix:MRS
First Name:OLUSOLA
Middle Name:
Last Name:ADEDEJI
Suffix:
Gender:F
Credentials:MS, RD, LD, LN
Other - Prefix:
Other - First Name:OLUSOLA
Other - Middle Name:
Other - Last Name:IDOWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8336
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20907-8336
Mailing Address - Country:US
Mailing Address - Phone:301-588-4440
Mailing Address - Fax:301-588-1011
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 934
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-588-4440
Practice Address - Fax:301-588-1011
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB00222133N00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q43861Medicare UPIN
MD169NL174Medicare ID - Type Unspecified