Provider Demographics
NPI:1952971368
Name:AYODELE, MODINAT 0
Entity Type:Individual
Prefix:MRS
First Name:MODINAT
Middle Name:0
Last Name:AYODELE
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 1:115 S WILKE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1519
Mailing Address - Country:US
Mailing Address - Phone:224-341-5658
Mailing Address - Fax:
Practice Address - Street 1:115 S WILKE RD STE 203
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1519
Practice Address - Country:US
Practice Address - Phone:224-341-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3002046376J00000X
IL4000707374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty