Provider Demographics
NPI:1205996907
Name:ADELAYO, ADEOLA (MD)
Entity type:Individual
Prefix:
First Name:ADEOLA
Middle Name:
Last Name:ADELAYO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ADEOLA
Other - Middle Name:
Other - Last Name:ODULATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3160
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85117-4115
Mailing Address - Country:US
Mailing Address - Phone:480-983-0065
Mailing Address - Fax:480-671-4541
Practice Address - Street 1:915 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6902
Practice Address - Country:US
Practice Address - Phone:406-414-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1123812084P0804X
IL036-1121802084P0800X
ORMD2163042084P0800X
IN01064165A2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT112381OtherMONTANA STATE LICENSE
IL036-112180OtherSTATE LICENSE NUMBER