Provider Demographics
NPI:1790087195
Name:AJAYI, KEHINDE MARGARET
Entity Type:Individual
Prefix:MRS
First Name:KEHINDE
Middle Name:MARGARET
Last Name:AJAYI
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 1:165 CLINTON AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3502
Mailing Address - Country:US
Mailing Address - Phone:347-285-8063
Mailing Address - Fax:
Practice Address - Street 1:165 CLINTON AVE APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3502
Practice Address - Country:US
Practice Address - Phone:718-802-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220163-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse