Provider Demographics
NPI:1760114342
Name:ADELEKAN, TITILAYO
Entity Type:Individual
Prefix:
First Name:TITILAYO
Middle Name:
Last Name:ADELEKAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-2714
Mailing Address - Country:US
Mailing Address - Phone:708-673-9850
Mailing Address - Fax:
Practice Address - Street 1:28945 STATE ROAD 54 STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-3218
Practice Address - Country:US
Practice Address - Phone:630-755-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025095363LF0000X
IL209025322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily