Provider Demographics
NPI:1619311859
Name:IBIYEYE, EMMANUEL O
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:O
Last Name:IBIYEYE
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 1:4100 53RD PL APT 6
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1437
Mailing Address - Country:US
Mailing Address - Phone:240-353-5551
Mailing Address - Fax:
Practice Address - Street 1:4100 53RD PL APT 6
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1437
Practice Address - Country:US
Practice Address - Phone:240-353-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide