Provider Demographics
NPI:1477994747
Name:ADEMENO, AYODEJI OLUWASEGUN
Entity Type:Individual
Prefix:
First Name:AYODEJI
Middle Name:OLUWASEGUN
Last Name:ADEMENO
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 1:8976 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1119
Mailing Address - Country:US
Mailing Address - Phone:240-838-8727
Mailing Address - Fax:
Practice Address - Street 1:8976 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1119
Practice Address - Country:US
Practice Address - Phone:240-838-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide