Provider Demographics
NPI:1467998302
Name:AJAGBE, SOHEEB FOLUSHO
Entity Type:Individual
Prefix:MR
First Name:SOHEEB
Middle Name:FOLUSHO
Last Name:AJAGBE
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 1:1114 FRIARTUCK TRL
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3084
Mailing Address - Country:US
Mailing Address - Phone:608-921-1227
Mailing Address - Fax:
Practice Address - Street 1:1114 FRIARTUCK TRL
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3084
Practice Address - Country:US
Practice Address - Phone:608-921-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion