Provider Demographics
NPI:1659629798
Name:ADELEYE, BOSEDE M (PMHNP)
Entity Type:Individual
Prefix:
First Name:BOSEDE
Middle Name:M
Last Name:ADELEYE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10903 N RIDING RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-8398
Mailing Address - Country:US
Mailing Address - Phone:301-512-9449
Mailing Address - Fax:301-512-9449
Practice Address - Street 1:6801 KENILWORTH AVE STE 300-S2
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1331
Practice Address - Country:US
Practice Address - Phone:301-512-9449
Practice Address - Fax:301-798-6260
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161903363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily