Provider Demographics
NPI:1740003888
Name:ADEDOKUN, AMEEDAT TITILOPE
Entity type:Individual
Prefix:
First Name:AMEEDAT
Middle Name:TITILOPE
Last Name:ADEDOKUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N HIGH SCHOOL RD STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3695
Mailing Address - Country:US
Mailing Address - Phone:317-291-1211
Mailing Address - Fax:
Practice Address - Street 1:602 N HIGH SCHOOL RD # B46214
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3694
Practice Address - Country:US
Practice Address - Phone:317-291-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016005A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily