Provider Demographics
NPI:1982339560
Name:ADETAYO, JOSHUA (NP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ADETAYO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CARROLL WALK AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6943
Mailing Address - Country:US
Mailing Address - Phone:301-473-6232
Mailing Address - Fax:240-667-7771
Practice Address - Street 1:504 CARROLL WALK AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6943
Practice Address - Country:US
Practice Address - Phone:301-473-6232
Practice Address - Fax:240-667-7771
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224016363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health