Provider Demographics
NPI:1841045820
Name:AYANDELE, ADEMOLA A (CASE WORKER)
Entity type:Individual
Prefix:MR
First Name:ADEMOLA
Middle Name:A
Last Name:AYANDELE
Suffix:
Gender:M
Credentials:CASE WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 DECLARATION DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-8834
Mailing Address - Country:US
Mailing Address - Phone:202-779-8473
Mailing Address - Fax:
Practice Address - Street 1:855 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:IN
Practice Address - Zip Code:46167-8834
Practice Address - Country:US
Practice Address - Phone:202-779-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator