Provider Demographics
NPI:1952955536
Name:BABATUNDE, ABOSEDE
Entity Type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:
Last Name:BABATUNDE
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 1:12627 HILLMEADE STATION DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3312
Mailing Address - Country:US
Mailing Address - Phone:301-675-0078
Mailing Address - Fax:
Practice Address - Street 1:3231 SUPERIOR LN STE A6
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1939
Practice Address - Country:US
Practice Address - Phone:301-675-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3732251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health