Provider Demographics
NPI:1558621417
Name:AWOFISIBE, KUNLE FOLAYAN
Entity Type:Individual
Prefix:
First Name:KUNLE
Middle Name:FOLAYAN
Last Name:AWOFISIBE
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 1:6841 RIVERDALE RD
Mailing Address - Street 2:APT 201
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737
Mailing Address - Country:US
Mailing Address - Phone:240-314-9761
Mailing Address - Fax:
Practice Address - Street 1:6841 RIVERDALE RD
Practice Address - Street 2:APT 201
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737
Practice Address - Country:US
Practice Address - Phone:240-314-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA121481258610374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide