Provider Demographics
NPI:1538650189
Name:AGBAJE, YETUNDE RISIKAT
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:RISIKAT
Last Name:AGBAJE
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 1:5397 QUINCY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1108
Mailing Address - Country:US
Mailing Address - Phone:240-468-0332
Mailing Address - Fax:
Practice Address - Street 1:5397 QUINCY ST APT 1
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1108
Practice Address - Country:US
Practice Address - Phone:240-468-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12034374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide