Provider Demographics
NPI:1770046948
Name:ADESOGAN, ADEDAYO
Entity Type:Individual
Prefix:
First Name:ADEDAYO
Middle Name:
Last Name:ADESOGAN
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 1:15 ROBERT AREY DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3742
Mailing Address - Country:US
Mailing Address - Phone:857-287-4925
Mailing Address - Fax:
Practice Address - Street 1:15 ROBERT AREY DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3742
Practice Address - Country:US
Practice Address - Phone:857-287-4925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2259322163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health