Provider Demographics
NPI:1801149570
Name:ADESIYAN, ADIJAT ALABA
Entity type:Individual
Prefix:
First Name:ADIJAT
Middle Name:ALABA
Last Name:ADESIYAN
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 1:6527 LANDOVER RD CHEVERLY
Mailing Address - Street 2:APT 102
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20106
Mailing Address - Country:US
Mailing Address - Phone:202-547-2949
Mailing Address - Fax:
Practice Address - Street 1:6527 LANDOVER RD CHEVERLY
Practice Address - Street 2:APT 102
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20106
Practice Address - Country:US
Practice Address - Phone:202-547-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide