Provider Demographics
NPI:1639430903
Name:FAMAKINWA, ADENIYI
Entity Type:Individual
Prefix:MR
First Name:ADENIYI
Middle Name:
Last Name:FAMAKINWA
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 1:3815 64TH AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1854
Mailing Address - Country:US
Mailing Address - Phone:202-276-3718
Mailing Address - Fax:
Practice Address - Street 1:3815 64TH AVE APT 203
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1854
Practice Address - Country:US
Practice Address - Phone:202-276-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide