Provider Demographics
NPI:1518609858
Name:ADEJIMI, MICHAEL OLUSEGUN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:OLUSEGUN
Last Name:ADEJIMI
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 1:500 FAIRWAY DRIVE, SUITE 102 DEERFIELD BEACH, FL
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:877-418-2978
Mailing Address - Fax:866-500-2186
Practice Address - Street 1:421 FAYETTEVILLE ST. SUITE 1100,
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601
Practice Address - Country:US
Practice Address - Phone:919-637-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst