Provider Demographics
NPI:1952883860
Name:AJAYI, OLUFUNSO OMOLARA
Entity Type:Individual
Prefix:
First Name:OLUFUNSO
Middle Name:OMOLARA
Last Name:AJAYI
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 1:9707 EVENING PRIMROSE DR APT 2C
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6322
Mailing Address - Country:US
Mailing Address - Phone:240-486-7656
Mailing Address - Fax:
Practice Address - Street 1:9707 EVENING PRIMROSE DR APT 2C
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-6322
Practice Address - Country:US
Practice Address - Phone:240-486-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13879374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide