Provider Demographics
NPI:1497146112
Name:JAIYEOLA, ABIODUN ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:ABIODUN
Middle Name:ELIZABETH
Last Name:JAIYEOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 BALTIMORE AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3641
Mailing Address - Country:US
Mailing Address - Phone:202-269-6000
Mailing Address - Fax:
Practice Address - Street 1:7100 BALTIMORE AVE STE 510
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3641
Practice Address - Country:US
Practice Address - Phone:202-269-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212534363LF0000X
DCRN1034790363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty