Provider Demographics
NPI:1821333642
Name:AFOLABI, WAIDI BAMIDELE
Entity Type:Individual
Prefix:
First Name:WAIDI
Middle Name:BAMIDELE
Last Name:AFOLABI
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 1:1352 JASPER PL SE APT 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2948
Mailing Address - Country:US
Mailing Address - Phone:202-716-9882
Mailing Address - Fax:
Practice Address - Street 1:1352 JASPER PL SE APT 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2948
Practice Address - Country:US
Practice Address - Phone:202-716-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide