Provider Demographics
NPI:1710301379
Name:ABESIN, ABIODUN ADESOLA
Entity Type:Individual
Prefix:MR
First Name:ABIODUN
Middle Name:ADESOLA
Last Name:ABESIN
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 1:3405 DODGE PARK RD
Mailing Address - Street 2:APARTMENT 103
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2013
Mailing Address - Country:US
Mailing Address - Phone:202-600-6632
Mailing Address - Fax:
Practice Address - Street 1:3405 DODGE PARK RD
Practice Address - Street 2:APARTMENT 103
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2013
Practice Address - Country:US
Practice Address - Phone:202-600-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2018-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9016374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide