Provider Demographics
NPI:1619307162
Name:SHOBALOJU, IBRAHIM OLASUNKANMI
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:OLASUNKANMI
Last Name:SHOBALOJU
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 1:3100 BRUCE PL SE APT 401
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2950
Mailing Address - Country:US
Mailing Address - Phone:202-704-1628
Mailing Address - Fax:
Practice Address - Street 1:3100 BRUCE PL SE APT 401
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2950
Practice Address - Country:US
Practice Address - Phone:202-704-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
DCHHA9601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health