Provider Demographics
NPI:1508584178
Name:ADEYINKA, ADEDAMOLA OLAYIWOLA
Entity Type:Individual
Prefix:
First Name:ADEDAMOLA
Middle Name:OLAYIWOLA
Last Name:ADEYINKA
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 1:6361 E OLD OTTO CT S
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-9672
Mailing Address - Country:US
Mailing Address - Phone:317-640-6707
Mailing Address - Fax:
Practice Address - Street 1:6361 E OLD OTTO CT S
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-9672
Practice Address - Country:US
Practice Address - Phone:317-640-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker