Provider Demographics
NPI:1578872446
Name:OLADEJO, FATIMO AYEGBOYIN
Entity Type:Individual
Prefix:
First Name:FATIMO
Middle Name:AYEGBOYIN
Last Name:OLADEJO
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 1:25720 CRAFT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3010
Mailing Address - Country:US
Mailing Address - Phone:646-388-0249
Mailing Address - Fax:
Practice Address - Street 1:25720 CRAFT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3010
Practice Address - Country:US
Practice Address - Phone:646-388-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY563729-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse