Provider Demographics
NPI:1184288870
Name:OLOWOMEYE, KAYODE A
Entity type:Individual
Prefix:
First Name:KAYODE
Middle Name:A
Last Name:OLOWOMEYE
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 1:2295 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-7977
Mailing Address - Country:US
Mailing Address - Phone:716-450-4161
Mailing Address - Fax:
Practice Address - Street 1:2295 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-7977
Practice Address - Country:US
Practice Address - Phone:716-450-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX461295824OtherN/A