Provider Demographics
NPI:1952488561
Name:ASHAYE, JAIYEOLA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAIYEOLA
Middle Name:A
Last Name:ASHAYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAIYEOLA
Other - Middle Name:AMINAT
Other - Last Name:KOLA-DAISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:824 S DIAMOND ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5960
Practice Address - Country:US
Practice Address - Phone:208-465-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH78930Medicare UPIN