Provider Demographics
NPI:1629455654
Name:AJAYI-LAMANNA, OLAYEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAYEMI
Middle Name:
Last Name:AJAYI-LAMANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLAYEMI
Other - Middle Name:
Other - Last Name:AJAYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-4005
Mailing Address - Country:US
Mailing Address - Phone:860-684-8280
Mailing Address - Fax:
Practice Address - Street 1:201 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076-4005
Practice Address - Country:US
Practice Address - Phone:860-684-8280
Practice Address - Fax:860-684-8285
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT66659208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program