Healthcare Provider Details

I. General information

NPI: 1952715294
Provider Name (Legal Business Name): ADEYINKA ADEBAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2014
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 E BASELINE RD STE 230
GILBERT AZ
85234-5450
US

IV. Provider business mailing address

704 WOODEWIND DR
NAPERVILLE IL
60563-3972
US

V. Phone/Fax

Practice location:
  • Phone: 602-838-4049
  • Fax: 310-496-0818
Mailing address:
  • Phone: 630-544-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018630
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6669
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: