Provider Demographics
NPI:1295318772
Name:ADEYEMO, OREOFE ADEDOTUN
Entity type:Individual
Prefix:
First Name:OREOFE
Middle Name:ADEDOTUN
Last Name:ADEYEMO
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 1:202 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2705
Mailing Address - Country:US
Mailing Address - Phone:903-422-2649
Mailing Address - Fax:
Practice Address - Street 1:202 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2705
Practice Address - Country:US
Practice Address - Phone:903-422-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty