Provider Demographics
NPI:1356624878
Name:ADELEYE, TIMOTHY A (LPN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:ADELEYE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S NULTON AVE
Mailing Address - Street 2:PALMER TOWNSHIP
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3767
Mailing Address - Country:US
Mailing Address - Phone:610-905-4753
Mailing Address - Fax:
Practice Address - Street 1:455 S. NULTON AVENUE
Practice Address - Street 2:PALMER TOWNSHIP
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-3767
Practice Address - Country:US
Practice Address - Phone:610-905-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN277373164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse