Provider Demographics
NPI:1669945879
Name:ADEYEMO, TAIWO O
Entity type:Individual
Prefix:
First Name:TAIWO
Middle Name:O
Last Name:ADEYEMO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAIWO
Other - Middle Name:O
Other - Last Name:ADEYEMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:11571 LAURELWALK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3001
Mailing Address - Country:US
Mailing Address - Phone:240-646-2414
Mailing Address - Fax:
Practice Address - Street 1:11571 LAURELWALK DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3001
Practice Address - Country:US
Practice Address - Phone:301-905-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1028137363L00000X
MDR203129363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner