Provider Demographics
NPI:1740015791
Name:AYEKO, AYODELE O
Entity type:Individual
Prefix:MRS
First Name:AYODELE
Middle Name:O
Last Name:AYEKO
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 1:22615 NAUGATUCK SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6642
Mailing Address - Country:US
Mailing Address - Phone:571-356-6197
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 9600
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9600
Practice Address - Country:US
Practice Address - Phone:571-356-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024161522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered