Provider Demographics
NPI:1508690561
Name:AWOLEYE, AYODELE
Entity type:Individual
Prefix:
First Name:AYODELE
Middle Name:
Last Name:AWOLEYE
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 1:14424 LOWER GUTHRIE CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6744
Mailing Address - Country:US
Mailing Address - Phone:763-607-8373
Mailing Address - Fax:763-322-0322
Practice Address - Street 1:9415 WEST RIVER ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:763-607-8373
Practice Address - Fax:763-322-0322
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility