Provider Demographics
NPI:1922632520
Name:AJAYI, FOLAWEWO ABIODUN (NP)
Entity Type:Individual
Prefix:
First Name:FOLAWEWO
Middle Name:ABIODUN
Last Name:AJAYI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 TANYARD ROAD, SUITE C100
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1676
Mailing Address - Country:US
Mailing Address - Phone:559-327-4768
Mailing Address - Fax:856-566-6384
Practice Address - Street 1:1474 TANYARD ROAD, SUITE C100
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1676
Practice Address - Country:US
Practice Address - Phone:559-327-4768
Practice Address - Fax:856-566-6384
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01012000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0750581Medicaid
NJ2A2187OtherMEDICARE PIN