Provider Demographics
NPI:1336811835
Name:ADEDEJI, OLAMIDE OLAIDE
Entity type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:OLAIDE
Last Name:ADEDEJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLAMIDE
Other - Middle Name:OLAIDE
Other - Last Name:OJO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:123 WEYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5632 ANNAPOLIS RD STE 9
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2213
Practice Address - Country:US
Practice Address - Phone:301-927-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200001474374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide